Utility of intracardiac echocardiography in left heart ablation for tachyarrhythmias

Catheter-based radiofrequency ablation in the left heart can provide effective therapy for tachyarrhythmias. The recent development of the real time intracardiac echocardiography (ICE) with 2D and Doppler color flow imaging can facilitate left heart ablation procedures. This report reviews the use of ICE during radiofrequency catheter ablation procedures for atrial fibrillation (AF) and ventricular tachycardia and is based on our own experience in 955 patients. ICE has a critical role for guiding transseptal catheterization, assisting placement of mapping/ablation catheters and monitoring lesion morphologic changes, especially in the pulmonary vein ostia, Marshall ligament region, thickened interatrial septum, left atrial posterior wall contiguous to esophagus, aortic valve cusps, and the epicardial regions. One of the more powerful utilities of ICE lies in its ability to identify and potentially reduce procedural complications including damage to intracardiac structures, residual atrial septal defect, left atrial thrombus formation, pulmonary vein stenosis, esophageal injury, myocardial air-embolizaion and pericardial effusion during left heart ablation.