Intracardiac echocardiography Chinese expert consensus

Abstract

In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.

Chinese expert consensus on the construction of the fluoroless cardiac electrophysiology laboratory and related techniques

“…[45][46][47] Although most manifestations are self-limited, a few require surgical treatment and may even life-threatening in severe cases. [48][49][50][51][52] Prevention recommendations are as follows: (1) Vascular ultrasound guidance should be utilized for femoral vein puncture to avoid arterial injury; (2) Retroperitoneal hemorrhage in the left femoral vein puncture is significantly higher than with right femoral vein puncture, 49 so the right femoral vein puncture is preferred for vascular access; (3) The basic principles of ICE catheter operation should be strictly followed 40,44 to ensure that the cavity can be seen at the tip interface when ICE catheter enters, to avoid damage to the vessel wall or venous valve when the ICE catheter is pushed; (4) When a retroperitoneal hematoma does indeed occur, criteria for transfer to an appropriate level of care unit should be evaluated promptly and the bleeding location should be determined, and the treatment principles are otherwise the same as if occurring in the traditional catheterization laboratory.…”

“…Fluoroless transseptal puncture can be performed under the guidance of ICE 34–36 or electroanatomic mapping (EAM). Transseptal puncture under the guidance of ICE is recommended for patients with complex cardiac structures, such as concomitant atrial septal aneurysm 37–40 …”

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

“…Melduni [25] 2022 2,950 AF patients prior to ECV Yes VKAs or NOACs at least 3 weeks 1.5% Faggiano [26] 2022 Intracardiac echocardiography (ICE) is a safe and effective alternative to transesophageal echocardiography for LAAT, [38] ICE can replace TEE for LAAT screening in AF patients undergoing LAAC and/or ablation without increased complications. [39] 4. Anticoagulation for LAA thrombus in patients with AF Ischemic stroke, transient ischemic attacks (TIA), and systemic embolism are major problems faced by AF patients, and for those with LAAT, embolic stroke is a high-probability event.…”

“…Intracardiac echocardiography (ICE) is a safe and effective alternative to transesophageal echocardiography for LAAT, [38] ICE can replace TEE for LAAT screening in AF patients undergoing LAAC and/or ablation without increased complications. [39]…”

Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage

“…The radial rotary system available in clinical practice, Ultra ICE™ (Boston Scientific), involves the application of a single piezoelectric crystal affixed to the pointed end of a French catheter with a mechanical 360° rotary ultrasound transducer. Its maneuverability is limited by the rotary ICE catheter (including a shortage of Doppler imaging and catheter diversion), 22 which must be placed in the RA with the guidance of a long sheath 23 . Therefore, the radial ICE system is currently used mainly in electrophysiological studies 24 .…”