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Transcatheter interventions for mitral and tricuspid regurgitation
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Transcatheter therapies for TR are still very much in their infancy.47 Treatment of the tricuspid valve, like the mitral valve, poses several anatomical challenges including the very large size of the annulus, the low flow velocity and low valve opening pressure, conformational changes during the cardiac cycle, the absence of annular and leaflet calcification, and the proximity of the conduction pathways (atrio-ventricular (AV) node and Bundle of His) in the Koch triangle, and of the right coronary artery in the AV groove adjacent to the annulus.48 Moreover, because of the very large annular size (normal area >9 cm2) and the anterior location of the valve, conventional intra-procedural imaging including TEE can be challenging. Nonetheless, several repair systems and a small number of tricuspid valve replacements have been evaluated clinically.49
Atypical tachycardia mimicking typical reentry: what is the mechanism?
Published in Acta Cardiologica, 2022
Hussam Ali, Guido De Ambroggi, Pierpaolo Lupo, Sara Foresti, Carmine De Lucia, Riccardo Cappato
Conventional radiofrequency ablation of the slow pathway at the inferior portion of Koch triangle produced prolonged junctional rhythm and rendered the tachycardia not inducible anymore. The patient remained asymptomatic and arrhythmia-free during the next 10-months follow-up period. This case highlights that atypical AVNRT, particularly at fast rates, may mimic common atrial flutter. The fast atrial rate can produce physiological AV block while focal atrial activation propagating from the slow pathway region is extremely slow, or functionally blocked, at the CTI mimicking counterclockwise atrial flutter activation pattern and producing flutter-like P waves on the surface ECG. Pacing manoeuvres, particularly from the ventricle by applying multiple extrastimuli to penetrate the circuit, are essential to elucidate the tachycardia mechanism and to guide successful catheter ablation.
High-Detailed evaluation of the right atrial anatomy by three-dimensional rotational angiography during ablation procedures for atrioventricular nodal reentrant tachycardia and atrial flutter
Published in Scandinavian Cardiovascular Journal, 2018
Christophe Garweg, Stijn De Buck, Bert Vandenberk, Rik Willems, Joris Ector
In the LARCA system, image clipping of the RA surface reconstruction allows vsualizing Koch’s triangle area. The three sides of Koch’s triangle were identified and measured. The components of Koch’s triangle were defined as follows (Figure 1, panel A):