The triangle of Koch is a landmark area on the lower right atrial septum that marks the position of the AV node. Its borders are the tendon of Todaro, the attachment of the septal leaflet of the tricuspid valve, and the opening of the coronary sinus. The compact AV node lies near its apex.
| Location | Lower interatrial septum on the right atrial side, just above the septal leaflet of the tricuspid valve. |
|---|---|
| Parts |
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A surface landmark rather than a working structure. It tells surgeons and electrophysiologists where the AV node lies so it can be avoided.
Electrophysiologists target the lower part of the triangle when ablating the slow pathway for AV nodal re-entrant tachycardia, keeping away from the apex to avoid heart block. Surgeons avoid deep sutures here during tricuspid and septal repairs for the same reason.
Damage to the AV node during ablation or surgery near the triangle. It may require a permanent pacemaker.
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