Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

Abstract

Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

Imaging with intracardiac echocardiography compared to transesophageal echocardiography during left atrial appendage occlusion

“…The use of procedural echocardiography is an essential requirement for safe and successful PLAAO. ICE is an imaging technique applied in various interventional cardiac procedures, such as catheter ablation of atrial fibrillation, percutaneous closure of atrial and ventricular septal defects, and mitral valvuloplasty (Biermann et al, 2012;Hijazi et al, 2009). More recently, ICE has been adopted to guide LAAO because of its advantages.…”

Intracardiac echocardiography for transseptal puncture. A guide for cardiac electrophysiologists

“…When the transseptal sheath is sufficiently descended and it reaches the foramen ovale, a sudden discrete movement towards the left atrium can be observed. This "jump" is a sign that allows the operator to know that the sheath is at the level of the foramen ovale [11].…”

“…ICE permits direct visualization of the endocardium and precisely locates the transseptal needle and the sheath in contact with the interatrial septum. ICE should be the preferred option for guiding a safe transseptal access in cases of a modified interatrial septum anatomy: thickened septum, floppy septum, interatrial septal aneurysm, lipomatous hypertrophy, previous suture of the septum after cardiac surgery, device closure of an atrial septal defect (ASD) [11]. The technique can be used also in cases with abnormal right atrial structures that interfere with the introduction of the needle, sheath and dilator into the right atrium, such as a prominent Eustachian ridge or a Chiari network [12][13][14].…”

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

“…In order to overcome the limitations of the procedures only guided by fluoroscopy, several authors exploited the application of new imaging modalities in TSP (Table 5), namely: transesophageal echocardiography (TEE) [19,[33][34][35][36][37][38], intracardiac echocardiography (ICE) [9,[39][40][41][42][43], real-time magnetic resonance (MR) [44] and direct color visualization [45]. Furthermore, needle tracking based on electromagnetic sensors [46] and electroanatomic mapping (EAM) [17,[47][48][49][50][51][52] were also presented.…”

“…Additionally, mechanical ICE is a lower cost strategy [40]. Finally, some authors presented interesting extended reports about ICE image guidance during TSP procedures, where a detailed explanation about atrial anatomy interpretation in ICE is presented [41][42][43].…”