Clinical applications of intracardiac echocardiography in interventional procedures

With the expanding development of percutaneous interventional procedures in the catheterisation laboratory, accurate online identification of intracardiac structures, catheters, and devices is mandatory. At present, the image modality most commonly used in the cath lab is fluoroscopy, which does not allow accurate evaluation of intracardiac structures. Besides TOE, ICE is at present the only imaging modality that can provide this information, combined with haemodynamic information during the procedures. ICE has a several clear advantages over the use of TOE, including less patient discomfort and no anesthesia, thus allowing communication with the patient during the procedure. Recently ICE has been implemented in a growing number of interventional procedures. Advantages of the clinical use of ICE are summarized in table 2. In conclusion, ICE is a valuable tool for guiding percutaneous interventional procedures, such as transseptal puncture and placement of closure devices. Efficiency is improved in electrophysiological interventional procedures by the ability to identify anatomical structures and integrate this information with electrophysiological information. Furthermore, ICE can be used as a diagnostic tool. Direct detection of intraprocedural complications, such as pericardial effusion and cardiac tamponade, is possible with ICE, allowing immediate intervention. Integration of ICE in procedures is likely to result in reduction of fluoroscopy and procedure times and improved outcome.