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The dimensions of the triangle of Koch in children

1999; Elsevier BV; Volume: 83; Issue: 1 Linguagem: Inglês

10.1016/s0002-9149(98)00794-2

1879-1913

Caren S. Goldberg, Michael J. Caplan, Kathleen P. Heidelberger, Macdonald Dick,

Cardiac electrophysiology and arrhythmias

The triangle of Koch, first described by Koch in 1909, 1 Koch W. Weiter mitteilungen uber den sinusknoten des Herzens. Verh Dt Ges Pathol. 1909; 13: 1985-1992 Google Scholar is bounded by the tricuspid valve annulus, the ostium of the coronary sinus, and the tendon of Todaro. The atrioventricular node is found at the apex of this triangle. Characterized by regions of slow conduction, the triangle of Koch is a critical site in the propagation of several forms of supraventricular tachycardia, namely, atrioventricular nodal reentrant tachycardia and atrial flutter. In addition, accessory pathways in the right posterior and posterior septal regions may course within the boundaries of Koch's triangle. Catheter ablation of these arrhythmias depend on the delivery of radiofrequency energy within the triangle of Koch. However, radiofrequency energy delivery to these areas may potentially produce atrioventricular nodal injury and block. Several studies have demonstrated that the approximate size of an ablation lesion from a 4-mm tip electrode catheter is 5 to 7 mm in diameter. 2 Mittleman R.S. Huang S.K.S. DeGuzman W.T. Cuenoud H. Wagshal A.B. Pires L.A. Use of the saline infusion electrode catheter for improved energy delivery and increased lesion size in radiofrequency catheter ablation. Pacing Clin Electrophysiol. 1995; 18: 1022-1027 Crossref PubMed Scopus (60) Google Scholar , 3 Huang S. Graham A. Lee M. Ring M. Gorman G. Schiffman R. Comparison of catheter ablation using radiofrequency versus direct current energy biophysiologic and pathologic observations. J Am Coll Cardiol. 1991; 18: 1091-1097 Abstract Full Text PDF PubMed Scopus (69) Google Scholar , 4 Fenrich A.L. Friedman R.A. Ott D.A. Nonpharmacologic trreatment of arrhythmias radiofrequency ablation and surgery. in: Garson A. Bricker J.T. Fisher D.J. Neish S.R. The Science and Practice of Pediatric Cardiology. Second Edition. Williams and Wilkins, Baltimore1998: 2472 Google Scholar Intuitively, one would expect that a smaller triangle of Koch would limit safe delivery of radiofrequency ablation energy. A recent study by McGuire and colleagues 5 McGuire M.A. Johnson D.C. Robotin M. Richards D.A. Uther J.B. Ross D.L. Dimensions of the triangle of Koch in humans. Am J Cardiol. 1992; 70: 829-830 Abstract Full Text PDF PubMed Scopus (34) Google Scholar included examination of 65 adult hearts either at the time of arrhythmic surgery (n = 45) or at autopsy (n = 20). In this adult population no relation between the body surface area and the dimensions of the triangle of Koch was demonstrated. To date, there are no reports of the dimensions of the triangle of Koch in children. In this study, we determined if the dimensions of Koch's triangle vary in relation to patient weight, height, body surface area, age, or heart weight in the pediatric population.