The contribution of intracardiac echocardiography in catheter ablation of ventricular arrhythmias

Abstract

Catheter ablation is a well-established treatment option for patients with ventricular arrhythmias. Recent advances in various imaging modalities, including three-dimensional electroanatomic mapping systems, magnetic resonance imaging, transesophageal and intracardiac echocardiography (ICE) have been adopted in catheter ablation of ventricular arrhythmias improving procedural outcome and safety. ICE is an imaging tool which provides real-time visualization of anatomical structures of the heart, facilitating catheter manipulation and navigation during ablation procedures. In this review we aim to highlight the benefits of ICE use in catheter ablation of ventricular arrhythmias and to describe practical techniques for visualization of cardiac structures with ICE during ventricular tachycardia ablations.

Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage

“…(including a shortage of Doppler imaging and catheter diversion), 22 which must be placed in the RA with the guidance of a long sheath. 23 Therefore, the radial ICE system is currently used mainly in electrophysiological studies.…”

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

“…Integration of ICE with 3D electroanatomical mapping systems has further increased the efficacy of real-time monitoring of both catheter and local anatomy, along with accurate identification of the PMs structure (size, shape, and number of heads). An important factor governing a successful ablation is the appropriate contact between the ablation catheter and the targeted tissue, as well as the correct location and stability of the catheter tip for optimum outcome ( 1 , 2 , 34 ). A single-center study conducted on more than 100 people described that ICE effectively identifies the catheter’s location and lesion distribution segments, reduces the surgical time and radiation exposure, and thus, improves the overall success rate of surgery ( 35 ).…”

Behind Enemy Lines: Vital Echocardiographic Data Prior to Ventricular Arrhythmia Ablation

“…Intracardiac echocardiography (ICE) generates 3-dimensional ventricular reconstruction that can be integrated in real-time with electroanatomic mapping. ICE provides real-time imaging of ventricular anatomy, catheter contact, and facilitates catheter manipulation during ablation [ 41 ].…”

“…LV access for endocardial mapping and VA ablation can be achieved either by retrograde transaortic or by antegrade transseptal approach. ICE has an important role in gaining safe left atrial access during transseptal puncture since it enables real-time visualization of the sheath-needle assembly, the fossa tenting and the puncturing the interatrial septum [ 41 ]. The technique is particularly valuable for VAs arising from sites with complex anatomy, such as periaortic VT and papillary muscle VT + RV free wall.…”

“…Futhermore, ICE facilitates significant reduction of radiation exposure during catheter ablation [ 45 ]. Zero fluoroscopy VT ablation is feasible using a combination of electroanatomic systems and ICE and achieving high acute success and low recurrence rates [ 41 ].…”