Intracardiac Echocardiography: Clinical Utility and Application

Abstract

Intracardiac echocardiography (ICE) broadens the spectrum of available echocardiographic techniques and provides the operator direct visualization of cardiac structures in real time. ICE has clear advantages over fluoroscopy, transthoracic echocardiography, and transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. With the development of steerable phased array catheters with low frequency and Doppler qualities, there is marked improvement in visualization of left-sided structures from the right heart. Appropriate utilization of ICE is likely to maximize safety and efficacy of complex interventional procedures and may improve patient outcomes. Future advances in ICE imaging will further improve the ease of device guidance and, in combination with new imaging modalities, could dramatically improve other applications of echocardiography which may result in improved patient outcomes. This review describes the technical evolution of ICE, the use of ICE in guiding percutaneous interventional procedures and possible future applications of ICE in the ever-growing field of interventional cardiology.

Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions

“…65,83,85,88,91,92,146,156 ICE offers imaging that is comparable to TEE and superior to TEE with respect to LA structures and the posterior-inferior rim of the septum. An additional 8F-11F sheath is required for the intracardiac echocardiographic system.…”

“…Its advantages include avoidance of general anesthesia, shorter procedure and fluoroscopy times, and comparable or lower cost to TEE-guided percutaneous closure when general anesthesia is used for those undergoing TEE-guided closure. 65,83,90,146 Three-dimensional ICE has been recently introduced, and the preliminary results reported from evaluating patients with structural heart disease are beginning to emerge. 95,97 Three-dimensional TEE offers RT3D imaging of the atrial septum, providing a comprehensive analysis of the defect and its relationship to the surrounding structures.…”

The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation

“…ICE provides excellent real-time near and far-field imaging of cardiac structures, allows for continuous monitoring with minimal interference with the ongoing intervention, and has the potential to reduce overall cost of cardiac interventions by improving efficiency and need for repeat interventions [1,11,12]. The clinical applications of ICE in this setting are broad [2] and include guidance during transseptal puncture [8,12], balloon valvuloplasty of the mitral valve [9], interventional electrophysiology procedures [11][12][13], atrial septal defect device closure [4,10], and, more recently, transcatheter aortic valve replacement [5].…”

Intracardiac Echocardiographic Diagnosis of Thrombus Formation in the Left Atrial Appendage: A Complementary Role to Transesophageal Echocardiography

“…Intracardiac echocardiography (ICE) with its real time high‐resolution imaging capability and excellent patient tolerance without need for general anesthesia is a useful diagnostic tool in interventional catheterization and electrophysiological ablation procedures . ICE improves the efficacy and safety of complex catheter ablation procedures: guiding catheter manipulation, evaluating tissue contact/lesion morphology, and allowing immediate recognition of complications when they arise.…”