Utility of Intracardiac Echocardiography in Left Heart Ablation for Tachyarrhythmias

Abstract

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-embolization and pericardial effusion during left heart ablation.

Role of Echocardiography in Atrial Fibrillation

“…Conventionally, temperature, power, and impedance are monitored during RF energy delivery. The appearance of microbubbles resulting from superheating can even precede increased impedance 70). Ablation needs to be terminated immediately if a sudden appearance of microbubbles is observed.…”

Right coronary artery ostial stenosis associated with idiopathic ventricular tachycardia ablation

“…Contrast radiography within the coronary cusp independent of selective CAG may provide more accurate information about the location of the ostial coronary artery. Intracardiac echocardiography with higher temporal resolution also may be useful to discern the relationship between the location of the coronary artery and the catheter and to monitor them continuously through the procedure 3, 13, 14…”

Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation

“…The role of intracardiac echocardiography (ICE) to guide ablation of atrial fibrillation (AF) and other complex arrhythmias is well recognized [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. However, the additional role of ICE in identifying an atrial thrombus immediately before ablation of AF is not well studied.…”