Use of Intracardiac Echocardiography during Atrial Fibrillation Ablation

Abstract

As the volume and complexity of catheter ablation of atrial fibrillation (AF) continue to rise, there is increasing attention directed at reducing exposure to ionizing radiation. This has led to the emergence of intracardiac echocardiography (ICE) as a stand-alone imaging modality guiding AF ablation. In addition to directing transseptal puncture, ICE may be used to identify left atrial structures and to guide the manipulation of catheters. ICE may also be used to visualize the esophagus in real-time and to assist with early identification of procedural complications. This review provides detailed step-by-step directions for identification of relevant structures and summarizes the use of ICE during AF ablation.

Transseptal access in pediatric and congenital electrophysiology procedures: defining risk

“…Studies examining alternative imaging techniques for leftsided ablations have become more prominent lately due to the development of 3D electroanatomic mapping and catheter navigation software [4][5][6][7][8][9][10]. These alternative or adjunctive modalities may increase procedure time and cost and additionally carry their own risks.…”

“…While use of this technology is an intriguing method to further decrease fluoroscopy exposure, the inability to visualize the transseptal sheath or dilator prior to advancement of the needle raises concerns about the safety of this technique. ICE is frequently used as an alternative imaging modality for TSP in adult atrial fibrillation ablations [6,7,10]. ICE catheters allow for visualization of puncture and early recognition of pericardial effusions.…”

“…Recent studies have evaluated alternative imaging methods in order to both increase the safety of TSP and decrease the need for radiation exposure to the patient. These methods have included transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and computerized electroanatomic mapping systems [4][5][6][7][8][9][10]. As these alternative techniques are developed, it is important to define the risk of complications during standard fluoroscopy guided TSP, in order for appropriate comparisons to be made.…”

Usefulness of intracardiac echocardiography during pulmonary vein isolation with the novel multipolar irrigated ablation catheter (nMARQTM)

“…Intracardiac echocardiography was performed using a 10F probe Acunav (Siemens Medical Solution distributed by Biosense Webster) or 10F probe SoundStar (Biosense Webster, Inc., Diamond Bar, CA), advanced through a percutaneous femoral vein access [10,11]. These catheters are equipped with a linear-phased array multi-frequency (5.5 to 10 MHz) transducer and connected to Vivid I system (GE Healthcare, USA) or Cypress system (Acuson Corp, Mountain View, CA).…”

“…Previous studies reported the usefulness of intracardiac echocardiography (ICE) during AF ablation to identify left atrial structures, to guide the manipulation of catheters and to support the early identification of procedural complications [9,10]. In this study, we investigated the usefulness of ICE to optimize the manipulation of nMARQ TM catheter during AF ablation.…”