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Clinical importance of Koch's triangle size in children: a study using 3-dimensional electroanatomical mapping
Naokata Sumitomo1, Shigeru Tateno, Yoshihide Nakamura
1Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan. naokata@med.nihon-u.ac.jp
Insights
Understanding the distance between the His bundle (HB) and coronary sinus (CS) in children is key to preventing atrioventricular block during catheter ablation procedures.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Catheter ablation within Koch's triangle poses a risk of complete atrioventricular block.
- Accurate anatomical knowledge is crucial for safe and effective ablation procedures in pediatric patients.
Purpose of the Study:
- To investigate the anatomical dimensions of the coronary sinus (CS) and His bundle (HB) in children.
- To determine the distance between the CS and HB and its relationship with patient growth parameters.
Main Methods:
- Utilized a 3-dimensional electroanatomical mapping system (CARTO) in 53 children without congenital heart disease.
- Measured the size of the HB recording area and CS, along with the distance between them.
Main Results:
- The size of the HB recording area was 148±97 mm², and the CS size was 66±44 mm².
- The CS size and the HB-CS distance (18±7 mm) were found to be proportional to body weight, length, and surface area.
- Catheter ablation was successful in 52 patients, with no instances of atrioventricular nodal injury.
Conclusions:
- CS size and HB-CS distance increase proportionally with a child's growth.
- Knowing the HB-ablation point distance aids in preventing atrioventricular node injury.
- Koch's triangle dimensions may offer supportive information for radiofrequency ablation in children, potentially reducing reliance on the CARTO system.
Background:
Catheter ablation inside the Koch's triangle has a risk for complete atrioventricular block.
Methods And Results:
The anatomic size of the coronary sinus (CS) and His bundle (HB) in children and the distance between them was studied using a 3-dimensional electroanatomical mapping system (CARTO). Fifty-three children (mean age, 11.8+/-3.7 years) without congenital heart disease (ie, 24 with atrioventricular re-entrant tachycardia, 18 with atrioventricular nodal re-entrant tachycardia, 7 with atrial tachycardia, 2 with ventricular tachycardia and 2 with atrial flutter) were studied. The size of the HB recording area was 148+/-97 mm2 and the size of the CS was 66+/-44 mm2. The size of the CS and the distance between the HB and CS (18+/-7 mm) were proportional to body weight, body length and body surface area. All patients underwent catheter ablation, including 25 ablations inside Koch's triangle. Catheter ablation was successful in 52 patients without any atrioventricular nodal injury.
Conclusions:
The CS size and the distance between the HB and CS increased proportionally with children's growth. To know the distance from the HB to the ablation point is useful in avoiding atrioventricular node injury, and information about the length of Koch's triangle may provide supportive information when applying radiofrequency energy inside Koch's triangle without needing to use the CARTO system in children, but this merits further investigation.
