Intracardiac echocardiography for transseptal puncture. A guide for cardiac electrophysiologists

Abstract

The key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Intracardiac echocardiography (ICE) is an attractive tool used in cardiac catheterization and electrophysiology labs to provide detailed images thatcan facilitate transseptal puncture. ICE permits a direct visualization of the endocardium and precisely locates the needle and the sheath against the interatrial septum. Two different ICE catheters are available: a phased array and a mechanical transducer, both being currently used in clinical practice. This paper describes the technique used for guiding transseptal puncture with ICE. Due to its advantages, ICE has currently become an important tool used to maximize the safety of the transseptal puncture and increase efficacy of interventional cardiology procedures.

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

“…11 ICE is regarded as an attractive tool frequently used in electrophysiology procedures to guide catheter orientation and contact, provide detailed images for transseptal puncture, and monitor for complications (Figure 9). 32,33 ICE describes the anatomy of LA and pulmonary rapidly and accurately, and guides the manipulation of catheters as well. 34 In addition, ICE provides superior quality images with shorter image distances and higher resolution from within the heart.…”

Percutaneous occlusion of transseptal puncture‐related free wall perforation at the coronary sinus with a ventricular septal occluder during left atrial appendage closure: A case report

“…However, if the transseptal puncture was performed under the guidance of TEE or if we used a left oblique projection to confirm the spot of puncture in the septum, this complication could have been avoided. In addition, intracardiac echocardiography (ICE) permits direct visualization of the endocardium and precisely locates the needle and the sheath against the atrial septum, which also increases the safety and the success rate of transseptal puncture, 10 especially in difficult cases, such as patients with aneurysmal or a thickened septum and patients with abnormally rotated hearts. Furthermore, ICE‐guided LAAC can be performed under local anesthesia and may potentially have advantages over TEE 11,12 .…”

Understanding the scope of intracardiac echocardiography in catheter ablation of ventricular arrhythmia

“…Several studies have described that transseptal puncture can be safely and effectively performed with ICE and 3D electroanatomical mapping system guidance and helps in reducing radiation exposure to patients and operators ( 14 , 15 ). It is difficult to puncture through the atrial septum with abnormal anatomical structures, such as atrial septal thickening and aneurysm, lipoma, atrial septum after previous cardiac surgery, and implantation of atrial septal occlude ( 16 ). Sometimes, due to its inability to be located under conventional fluoroscopy, certain complications occur, namely, pericardial tamponade, aortic root puncture, arterial embolism, and pulmonary vein perforation ( 17 ).…”