Triangle of Koch

Last revised by Domenico Nicoletti on 16 Jul 2023

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.

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.

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