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• W4280496659 abstract "We thank Anderson et al for sharing some incisive insights into the anatomical correlations to the atrioventricular node on the basis of their seminal work and recent refinements in the understanding of anatomical relationships of the branching and nonbranching bundles, atrioventricular (AV) node, triangle of Koch, and the inferior pyramidal space to the inferoseptal recess of the left ventricular outflow tract. 1 Hikspoors J.P.J.M. Macias Y. Tretter J.T. et al. Miniseries 1—Part 1: the development of the atrioventricular conduction axis. Europace. 2022; 24: 432-442 Crossref PubMed Scopus (1) Google Scholar , 2 Macias Y. de Almeida M.C. Tretter J.T. et al. Miniseries 1—Part II: the comparative anatomy of the atrioventricular conduction axis. Europace. 2022; 24: 443-454 Crossref PubMed Scopus (3) Google Scholar , 3 Tretter J.T. Spicer D.E. Sanchez-Quintana D. Sternick E.B. Farre J. Anderson R.H. Miniseries 1—Part III: ‘behind the scenes’ in the triangle of Koch. Europace. 2022; 24: 455-463 Crossref PubMed Scopus (6) Google Scholar They have made major contributions to our anatomical understanding of this region. On the basis of their comments and the goal of every clinical electrophysiologist performing ablation in this region to avoid AV block while achieving successful ablation of an arrhythmogenic structure, it is our opinion that a universally accepted fluoroscopic identification of the AV node and the perihisian/parahisian area without taking into consideration the electrophysiological recordings of that area is not possible because of the rotation of the aortic root and the relative positions of the aortic sinuses. We would like to refine our statement in the editorial by stating that “ablation at a site with a larger amplitude atrial electrogram, a smaller amplitude His and ventricular electrogram predicts a higher risk of AV nodal block; this area could have high interindividual variability depending on aortic root rotation, and the individual variability of the inferoseptal recess, the triangle of Koch and aortic sinus relative to the conduction axis.” To the Editor— The anatomical correlations to the atrioventricular nodeHeart RhythmVol. 19Issue 8PreviewBerte et al1 have revealed what can be achieved in terms of imaging the atrioventricular junction, showing the varying relation of the atrioventricular node within the triangle of Koch. We were therefore surprised that in the accompanying editorial, Koneru and Ellenbogen2 suggested that the variation in position might reflect the relationship of the ventricular component of the atrioventricular conduction axis to the crest of the muscular ventricular septum. It is the Hisc-only cloud as shown by Berte et al that represents the nonbranching and branching bundles. Full-Text PDF" @default.
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• W4280496659 date "2022-08-01" @default.
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• W4280496659 title "Reply to the Editor— The anatomical correlations to the atrioventricular node" @default.
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• W4280496659 doi "https://doi.org/10.1016/j.hrthm.2022.05.016" @default.
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