The Emerging Role of Intracardiac Echocardiography -- Into the ICE Age

Andrew R.J. Mitchell; Prasanna Puwanarajah; Jonathan Timperley; Harald Becher; Neil Wilson; Oliver J. Ormerod

Disclosures

Br J Cardiol. 2007;14(1):31-36. 

In This Article

Electrophysiological Studies

Interventional electrophysiology has traditionally been performed using fluoroscopic landmarks and electrical mapping catheters. Successful ablation requires good delineation of anatomical structures combined with good lesion formation. ICE permits confirmation of stable, complete catheter-tissue contact, ensuring more complete electrical isolation and reducing the incidence of catheter clot formation.[8] To prevent tissue overheating (and therefore scar formation, thrombosis or stenosis), operators can deliver ablation until the onset of micro-bubble formation, ensuring maximal safe delivery of therapy. During left atrial ablation for atrial fibrillation, accurate positioning of the catheters is required and ICE is perfectly suited to guide the operator,[9] Additionally, ICE can identify thrombus in the left atrium or left atrial appendage and complications occurring within the pulmonary veins (figure 5).

Figure 5.

Colour-flow echocardiogram of the left-sided pulmonary veins.

Use of ICE during ablation of AF to confirm both catheter placement and ablation delivery has been shown to be more successful and with fewer embolic complications than in those cases performed without ICE.[10] One important component of modern ablation techniques is the ability to perform a transseptal puncture to access the left atrium. Even in the most skilled hands this can be difficult; complications include cardiac tamponade and aortic perforation. ICE provides extremely clear views of the interatrial septum to guide the interventionalist and confirm needle positioning.[11]

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