REVIEWS  ECHOCARDIOGRAPHY UPDATE 

Minerva Cardioangiologica 2010 June;58(3):333-42

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Intracardiac echocardiography in electrophysiology

Dello Russo A. ¹, Casella M. ¹, Pelargonio G. ², Bonelli F. ², Santangeli P. ², Fassini G. ¹, Riva S. ¹, Carbucicchio C. ¹, Giraldi F. ¹, De Iuliis P. ¹, Bartoletti S. ², Pintus F. ¹, Di Biase L. ³, Pepi M. ¹, Natale A. ³, Fiorentini C. ¹, Tondo C. ¹ ✉

¹ Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, Department of Cardiovascular Research, University of Milan, Milan, Italy; ² Institute of Cardiology, Sacro Cuore Catholic University, Rome, Italy; ³ Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

Intracardiac echocardiography (ICE) is a recent, invaluable tool which can provide real-time anatomical guidance in electrophysiological procedures. By inserting intravenously an ultrasound probe and advancing it into the heart, various different views can be obtained which allow to better visualize patient anatomy, to guide the placement of electrophysiological catheters, and to detect immediately procedural complications as they occur. In atrial fibrillation ablation, ICE proves particularly useful to achieve a safer trans-septal puncture (especially in the presence of anatomical anomalies of the interatrial septum) and to help to monitor the visualization of the mapping catheters (circular, high density), or the monitoring of the balloons catheter (Cryo, Laser) position. In ventricular tachycardia ablation, on the other hand, ICE allows for continuous correlation between electrophysiological and structural findings (such as wall motion anomalies or changes in echodensity), and helps to ensure correct catheter contact and to position it, particularly around delicate structures such as the aortic cusps. In any procedure, ICE is also useful to immediately detect procedural complications, such as thrombus formation along catheters, or pericardial effusion. Thanks to its real-time morphological information, ICE provides an ideal complement to simple fluoroscopy or to more complex electroanatomic mapping techniques and is set to gain a wider role in a broad range of electrophysiological procedures.