Triangle of Koch
The triangle of Koch or Koch’s triangle is an important landmark for atrioventricular catheter ablation procedures for the localization of the atrioventricular node.
From a right atrial viewpoint, the triangle of Koch is delineated by the hinge of the septal tricuspid valve leaflet anteriorly and the Eustachian ridge or tendon of Todaro posteriorly. The base is laid out by the ostium of the coronary sinus and its apex shows the central fibrous body of the heart, which is formed by the right fibrous trigone and the atrioventricular membranous septum. The transitional part of the atrioventricular node is found towards its base whereas the compact node is located beneath its apex 1.
The proximal atrioventricular conduction axis is supplied by the atrioventricular nodal artery 1.
History and etymology
The triangle of Koch was first described and named after the German pathologist Walter Koch 3.
Koch’s triangle constitutes a target area for ablation procedures of atrioventricular nodal reentrant tachycardia or atrial flutter 1.
- 1. Saremi F, Hassani C, SÃ¡nchez-Quintana D. Septal Atrioventricular Junction Region: Comprehensive Imaging in Adults. (2016) Radiographics : a review publication of the Radiological Society of North America, Inc. 36 (7): 1966-1986. doi:10.1148/rg.2016160010 - Pubmed
- 2. Klimek-Piotrowska W, Holda MK, Koziej M, Salapa K, Piatek K, Holda J. Geometry of Koch's triangle. (2017) Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 19 (3): 452-457. doi:10.1093/europace/euw022 - Pubmed
- 3. Walter Koch. Weitere Mitteilungen über den Sinusknoten des Herzens. (1909) Verhandlungen der Deutschen Pathologischen Gesellschaft.13: 85-92.