University of Chicago Medicine Center for Arrhythmia Care, Heart and Vascular Center, Chicago, Illinois.
Boston Scientific Corporation, Natick, Massachusetts.
Heart Rhythm. 2018 Mar;15(3):421-429. doi: 10.1016/j.hrthm.2017.10.030. Epub 2017 Nov 26.
Dedicated mapping studies of the triangle of Koch to characterize retrograde fast pathway activation have not been previously performed using high-resolution, 3-dimensional, multielectrode mapping technology.
To delineate the activation pattern and spatial distribution of the retrograde fast pathway within the triangle of Koch during typical atrioventricular nodal reentrant tachycardia (AVNRT) and right ventricular pacing in a consecutive series of patients using the Rhythmia mapping system (Boston Scientific, Natick, MA).
A total of 18 patients with symptomatic typical AVNRT referred for ablation underwent ultra high-density mapping of atrial activation with minielectrode basket configuration during tachycardia. The earliest atrial activation was mapped using automated annotation, with manual overreading by 2 independent observers. The triangle of Koch was classified into 3 anatomic regions: anteroseptal (His), midseptal, and posteroseptal (coronary sinus roof). Thirteen patients underwent mapping of atrial activation during ventricular pacing.
A median of 422 mapping points (interquartile range 258-896 points) was acquired within the triangle of Koch during tachycardia. The most common site of earliest atrial activation within the triangle of Koch was anterior in 67% of patients (n = 12). Midseptal early atrial activation was seen in 17% (n = 3), and posteroseptal activation was observed in 11% (n = 2). One patient exhibited broad simultaneous activation of the entire triangle of Koch. Slow pathway potentials were not identified.
With high-resolution multielectrode mapping, atrial activation during typical AVNRT exhibited anatomic variability and spatially heterogeneous activation within the triangle of Koch. These findings highlight the limitations of an anatomically based classification of atrioventricular nodal retrograde pathways.
以前没有使用高分辨率、三维、多电极标测技术对 Koch 三角进行专门的标测研究，以描述逆行快径激活。
使用 Rhythmia 标测系统（波士顿科学公司，马萨诸塞州纳提克），在一系列连续的患者中，对典型房室结折返性心动过速（AVNRT）和右室起搏时 Koch 三角内逆行快径的激活模式和空间分布进行描绘。
共 18 例有症状的典型 AVNRT 患者接受消融治疗，在心动过速期间使用微型电极篮状结构对心房激动进行超高密度标测。最早的心房激动采用自动注释进行标测，由 2 名独立观察者进行手动复查。Koch 三角分为 3 个解剖区域：前间隔（希氏束）、中隔和后间隔（冠状窦顶）。13 例患者在心室起搏时进行心房激动标测。
心动过速期间，在 Koch 三角内采集中位数为 422 个标测点（四分位距 258-896 个点）。Koch 三角内最早心房激动的最常见部位是前间隔占 67%（n=12）。中隔早期心房激动占 17%（n=3），后间隔激活占 11%（n=2）。1 例患者表现为整个 Koch 三角的广泛同步激活。未识别到慢径电位。
采用高分辨率多电极标测，典型 AVNRT 时的心房激动表现出 Koch 三角内的解剖变异性和空间异质性激活。这些发现突出了基于解剖的房室结逆行途径分类的局限性。
