Use of Intracardiac Echocardiography in Interventional Cardiology

Abstract

The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. For these reasons, ICE has largely replaced transesophageal echocardiography as ideal imaging modality for guiding certain procedures, such as atrial septal defect closure and catheter ablation of cardiac arrhythmias, and has an emerging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluoroscopy, such as the interatrial or interventricular septum, papillary muscles, and intracavitary muscular ridges. Most recently, a three-dimensional (3D) volumetric ICE system has also been developed, with potential for greater anatomic information and a promising role in structural interventions. In this state-of-the-art review, we provide guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.

Comparison of intracardiac and transoesophageal echocardiography for guidance of percutaneous left atrial appendage occlusion: A meta‐analysis

“…Several views and probe positions for LAA visualization have been described. 29 In initial reports of ICE-guided LAAO, the ICE probe was positioned in the right heart. 17,30 A later trend, however, was to advance the ICE probe into the left atrium (LA) to optimize LAA visualization.…”

Three-dimensional intracardiac echocardiography and pulmonary embolism

“…Intracardiac echocardiography is mostly used by electrophysiologists and interventional cardiologists. Its proximity to the cardiac structures creates unique imaging capabilities for the assessment of cardiac anatomy, intracardiac masses and procedural guidance in interventional cardiology [4]. However, the technique is invasive, which increases the risk of iatrogenic complications.…”

Intracardiac Echocardiography Instead of Transesophageal Echocardiography in Surgical Aortic Valve Replacement

“…Intracardiac echocardiography (ICE) is a widely used alternative modality for monitoring some cardiac catheter procedures, including transcatheter aortic valve implantation. 1,2 Although transesophageal echocardiography (TEE) is a standard echocardiographic monitoring modality for open cardiac surgery in a clinical setting, it has several contraindications. To the best of our knowledge, there are no reports on the clinical application of ICE in open cardiac surgery.…”

“…ICE is now a standard echocardiographic monitoring modality during percutaneous transcatheter closure of atrial septal defects and balloon aortic valvuloplasty, and it is increasingly being used in other cardiac catheter procedures, including transcatheter aortic valve implantation. 1,2 Therefore, ICE is a common monitoring modality used by cardiologists. However, anesthesiologists may not be well acquainted with the use of ICE in contrast to TEE.…”