Advantages of intracardiac echocardiography to guide interventional procedures

Advantages of intracardiac echocardiography to guide interventional procedures

Intracardiac echocardiography (ICE) has been in use for guiding electrophysiological procedures for quite some time. Now it is being used more and more in interventions for structural heart disease. Following are the advantages of ICE over TEE (transesophageal echocardiography):

1. ICE can be performed without the need for a second operator, by the primary operator alone
2. It can be performed under conscious sedation, there is no need for general anaesthesia, which also avoids endotracheal intubation
3. There is no risk of esophageal injury
4. Reduces fluoroscopy time and hence the radiation risk to patient and operator
5. Shortens procedure time
6. Facilitates early recognition of thrombus formation or pericardial effusion
7. May improve outcome

ICE can provide high resolution real time imaging of cardiac structures and continuous monitoring of catheter location within the heart [1]. ICE has mostly replaced TEE as ideal modality for closure of atrial septal defect and catheter ablation of cardiac arrhythmias in centres where it is freely available. It has an emerging role in mitral valvuloplasty, transcatheter aortic valve replacement (TAVI) and left atrial appendage closure.

In EP procedures, ICE permits real time integration with electroanatomic maps. It can also be used for visualizing structures not seen on fluoroscopy like interatrial and interventricular septum, papillary muscles and muscular ridges. Recently a three dimensional (3D) volumetric ICE system has also been developed [1].

Reference

1. Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, Garcia F. Use of Intracardiac Echocardiography in Interventional Cardiology. Working With the Anatomy Rather Than Fighting It. Circulation. 2018;137:2278-2294.