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Revisiting right anterior oblique projections for the triangle of Koch: implications from computed tomography

Yanjing Wang1, Lin Liu1, Robert Lakin2

  • 1Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai street, Changchun, Jilin Province, 130033, China.

BMC Cardiovascular Disorders
|August 26, 2020
PubMed

Insights

The coronary sinus ostium direction reliably predicts the triangle of Koch orientation, improving ablation accuracy. A new CS-guided projection reduces image shortening during atrioventricular node ablation.

Area of Science:

  • Cardiac electrophysiology
  • Interventional cardiology
  • Anatomical imaging

Background:

  • Variability in the triangle of Koch (TK) anatomy complicates atrioventricular (AV) node ablation.
  • Accurate anatomical assessment is crucial for successful ablation procedures.

Purpose of the Study:

  • To assess TK anatomical orientation and coronary sinus ostium (CSo) direction using CT angiography.
  • To validate an individualized CS-guided projection for improving ablation accuracy.

Main Methods:

  • CT angiography in 104 patients to determine TK orientation relative to CSo and standard RAO projections.
  • Validation of a CS-guided RAO projection (RAOCS) against traditional RAO30° and 45° angles.
  • In vivo assessment in 25 patients undergoing catheter ablation.

Main Results:

  • TK orientation strongly correlated with CSo direction (r=0.86, P<0.001).
  • The CS-guided projection minimized image shortening compared to traditional RAO angles.
  • Mean relative difference between CSo and TK orientation was 5.54 ± 0.48°.

Conclusions:

  • CSo direction is a reliable predictor of TK orientation in normal hearts.
  • A CS-guided projection enhances guidance during AV node ablation procedures.
Abstract

Keywords:
AVNRTAblationAnatomyCardiac CTTriangle of Koch’s

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