Abstract：
Numerous studies have clarified the histological characteristics of the area surrounding the atrioventricular (AV) node, commonly referred to as the triangle of Koch (ToK). Although it is suggested that the conduction of electric impulses from the atria to the ventricles via the AV node involves myocytes possessing distinct conduction properties and gap junction proteins, a comprehensive understanding of this complex conduction has not been fully established. Moreover, although various pathways have been proposed for both anterograde and retrograde conduction during atrioventricular nodal reentrant tachycardia (AVNRT), the reentrant circuits of AVNRT are not fully elucidated. Therefore, the slow pathway ablation for AVNRT has been conventionally performed, targeting both its anatomical location and slow pathway potential obtained during sinus rhythm. Recently, advancements in high-density three-dimensional (3D) mapping systems have facilitated the acquisition of more detailed electrophysiological potentials within the ToK. Several studies have indicated that the activation pattern, the low-voltage area within the ToK obtained during sinus rhythm, and the fractionated potentials acquired during tachycardia may be optimal targets for slow pathway ablation. This review provides an overview of the tissue surrounding the AV node as reported to date and summarizes the current understanding of AV conduction and AVNRT circuits. Furthermore, we discuss recent findings on slow pathway ablation utilizing high-density 3D mapping systems, exploring strategies for optimal slow pathway ablation.
摘要：
许多研究已经阐明了房室（AV）结周围区域的组织学特征，通常被称为科赫三角（ToK）。尽管有人建议通过房室结从心房到心室的电脉冲传导涉及具有不同传导特性和间隙连接蛋白的肌细胞，对这种复杂传导的全面理解尚未完全建立。此外，尽管房室结折返性心动过速（AVNRT）期间的顺行和逆行传导已提出了各种途径，AVNRT的折返回路尚未完全阐明。因此,AVNRT的慢路径消融已常规进行，针对其解剖位置和窦性心律期间获得的慢通路电位。最近,高密度三维（3D）映射系统的进步促进了ToK内更详细的电生理电位的获取。一些研究表明，激活模式，在窦性心律期间获得的ToK内的低电压区域，在心动过速期间获得的分割电位可能是慢速路径消融的最佳目标。这篇综述提供了迄今为止报道的房室结周围组织的概述，并总结了目前对房室传导和房室折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返性折返此外，我们讨论了利用高密度3D标测系统进行慢速路径消融的最新发现，探索最佳慢通路消融的策略。
