Intracardiac Echocardiography: Enhancing Electrophysiological Studies and Expanding Applications Volume 50- Issue 1

Zouhir Dindane* and Axel Linke

• Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany

Received: April 19, 2023;   Published: April 28, 2023

*Corresponding author: Zouhir Dindane, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76 01307 Dresden, Germany

DOI: 10.26717/BJSTR.2023.50.007899

Abstract PDF

Intracardiac echocardiography (ICE) has emerged as a pivotal imaging modality in cardiac electrophysiological studies and structural heart interventions, providing real-time visualization of cardiac structures and improved procedural guidance. ICE has proven particularly valuable in atrial fibrillation ablation, ventricular tachycardia ablation, transcatheter aortic valve implantation (TAVI), transcatheter tricuspid valve repair, mitral valve repair, and left atrial appendage closure. Despite challenges such as the learning curve and equipment costs, the potential for advancements in ICE technology is significant, with developments in three-dimensional imaging, higher resolution probes, integration with other imaging modalities, and incorporation of automation and artificial intelligence. As ICE continues to evolve, its impact on patient outcomes and procedural safety is expected to grow, further solidifying its role in the management of cardiac conditions.

Abbreviations: ICE: Intracardiac Echocardiography; TAVI: Transcatheter Aortic Valve Implantation; EPS: Electrophysiological Studies; TEE: Transesophageal Echocardiography

Intracardiac echocardiography (ICE) has emerged as a vital imaging modality in cardiac electrophysiological studies (EPS) and structural heart interventions, offering real-time visualization of cardiac structures and improved procedural guidance. This article explores the various applications and benefits of ICE in electrophysiological studies, its role in other cardiac procedures, and its potential for future advancements.

Traditionally, transesophageal echocardiography (TEE) and fluoroscopy have been the primary imaging modalities used in EPS. However, ICE has proven to be a valuable addition, providing enhanced visualization of intracardiac structures, catheter positioning, and device placement.

1. Atrial Fibrillation Ablation: ICE has become particularly useful during catheter ablation procedures for atrial fibrillation. It aids in assessing pulmonary vein anatomy, guiding transseptal puncture, and monitoring for potential complications, such as pericardial effusion or thrombus formation [1].

2. Ventricular Tachycardia Ablation: ICE can also be instrumental in ventricular tachycardia ablation, helping to visualize the ventricular myocardium and delineate the scar tissue responsible for arrhythmia [2].

Apart from electrophysiological studies, ICE has found applications in various structural heart disease interventions:

1. Transcatheter Aortic Valve Implantation (TAVI): ICE can be employed in TAVI procedures to visualize aortic annulus dimensions, valve positioning, and paravalvular regurgitation, enabling accurate device placement and minimizing complications [3].

2. Tricuspid Valve Repair: ICE has been shown to speed up Edge-to-Edge procedures since it improves visualization of leaflet grasping. In addition, ICE is instrumental in visualizing the annulus, which is especially in Cardio band procedures of extraordinary help. In both settings, ICE helps to optimize valve repair, which might have an impact on patients’ outcomes.

3. Mitral Valve Repair: ICE has proven valuable in guiding percutaneous mitral valve repair procedures, such as Mitra Clip implantation. It provides real-time visualization of the mitral valve leaflets and the clip during device positioning, ensuring optimal repair [4].

4. Left Atrial Appendage Closure: ICE is crucial for guiding left atrial appendage closure procedures by assessing appendage morphology, size, and thrombus presence, thus ensuring safe and effective device implantation [3].

Despite the numerous benefits of ICE in electrophysiological studies and structural heart interventions, certain challenges remain. One of the primary concerns is the learning curve associated with ICE, which necessitates dedicated training and experience (Bartel et al.,2016). Moreover, the cost of ICE equipment may be prohibitive for some institutions, limiting its widespread adoption.

Looking forward, the potential for further advancements in ICE technology is significant:

1. Three-Dimensional ICE: Developments in three-dimensional ICE will allow for more detailed images of cardiac structures, further refining the accuracy and safety of electrophysiological and structural heart procedures.

2. Higher-Resolution Probes: The advent of higher-resolution probes will provide even clearer images, enhancing procedural guidance and reducing the need for supplementary imaging modalities.

3. Integration with Other Imaging Modalities: The integration of ICE with other imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), is expected to enhance procedural guidance and streamline workflows. The fusion of ICE images with pre-procedural CT or MRI scans can help create detailed roadmaps for interventions, enabling precise navigation and potentially improving patient outcomes [3].

4. Automation and Artificial Intelligence: The incorporation of automation and artificial intelligence into ICE technology may facilitate faster, more accurate interpretations of images and expedite decision-making during cardiac procedures. This could lead to improved efficiency and reduced procedure times, ultimately benefiting both clinicians and patients.

Intracardiac echocardiography has undeniably become a vital imaging modality in modern electrophysiological studies and structural heart interventions. Its ability to provide real-time, high-resolution images of the heart’s structures has transformed the landscape of cardiac electrophysiology and structural heart disease management. As ICE technology continues to evolve, its impact on patient outcomes and procedural safety is expected to grow, enabling more effective treatments for a wide range of cardiac conditions. The potential advancements in ICE, including three-dimensional imaging, higher resolution probes, integration with other imaging modalities, and the application of automation and artificial intelligence, promise to further enhance the role of ICE in the rapidly evolving field of cardiovascular medicine.

The authors have declared that no competing interests exist.

1. John D Ferguson, Adam Helms, J Michael Mangrum, Srijoy Mahapatra, Pamela Mason, et al. (2019) Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol 2(6): 611-619.
2. David F Briceño, Andres Enriquez, Jorge Romero, Carlos Tapias, Pasquale Santangeli, et al. (2020) How to use intracardiac echocardiography to identify ventricular tachycardia substrate in ischemic cardiomyopathy. HeartRhythm Case Rep 6(10): 663-670.
3. Mohamad Alkhouli, Ziyad M Hijazi, David R Holmes Jr, Charanjit S Rihal, Susan E Wiegers (2018) Intracardiac Echocardiography in Structural Heart Disease Interventions. JACC Cardiovascular Interventions 11(21): 2133-2147.
4. Frank E Silvestry, Mitul B Kadakia, Judi Willhide, Howard C Herrmann (2014) Initial experience with a novel real-time three-dimensional intracardiac ultrasound system to guide percutaneous cardiac structural interventions: a phase 1 feasibility study of volume intracardiac echocardiography in the assessment of patients with structural heart disease undergoing percutaneous transcatheter therapy. J Am Soc Echocardiography 27(9): 978-983.