Visualization of elusive structures using intracardiac echocardiography: Insights from electrophysiology

Abstract

Electrophysiological mapping and ablation techniques are increasingly used to diagnose and treat many types of supraventricular and ventricular tachycardias. These procedures require an intimate knowledge of intracardiac anatomy and their use has led to a renewed interest in visualization of specific structures. This has required collaborative efforts from imaging as well as electrophysiology experts. Classical imaging techniques may be unable to visualize structures involved in arrhythmia mechanisms and therapy. Novel methods, such as intracardiac echocardiography and threedimensional echocardiography, have been refined and these technological improvements have opened new perspectives for more effective and accurate imaging during electrophysiology procedures. Concurrently, visualization of these structures noticeably improved our ability to identify intracardiac structures. The aim of this review is to provide electrophysiologists with an overview of recent insights into the structure of the heart obtained with intracardiac echocardiography and to indicate to the echo-specialist which structures are potentially important for the electrophysiologist.

Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports

“…During a standard ICE examination, sequential pull-back of the probe from the superior vena cava through the right atrium to the inferior vena cava allows a detailed identification of important structures such as: the crista terminalis; the right atrial appendage; the caval and the coronary sinus orifices; the fossa ovalis; the ascending aorta and its root; the pulmonary artery; the right ventricle and all of the cardiac valves [12-14]. Thus, this technique has the potential to provide a direct visualization of the endocardium and to precisely locate the ablation catheter which can be identified by the highly specific fan-shaped echocardiographic artefact of the large tip of the ablation electrode [11,12].…”

Sustainability in the cardiac cath lab

“…These radioprotection assumptions have been recently corroborated by direct assessment of increased chromosomal aberrations in peripheral lymphocytes of young adolescents who were exposed to low-level radiation at age < 1 year for congenital heart disease [25]. In this context, ICE-assisted ablation of atrial fibrillation [26] or MRI-guided cardiac catheterization and intervention in children [27] are especially attractive options for abating societal and individual costs of long-term damage. Eventually, the sustainability will become a dominant issue in medical imaging-and especially in the cath lab, which is at present the epicentre of the contemporary medical radiological tsunami.…”

Three‐Dimensional Echocardiography in the Electrophysiology Laboratory

“…Users can also manually identify critical anatomic structures that will be visualized in the map. Relevant structures that warrant special attention include the mitral valve, the esophagus, and the LA appendage 4,6 . Additional 3D anatomic shells are frequently obtained with CT or MR angiography and merged with the electrical map 3…”

“…Relevant structures that warrant special attention include the mitral valve, the esophagus, and the LA appendage. 4,6 Additional 3D anatomic shells are frequently obtained with CT or MR angiography and merged with the electrical map. 3 The second strategy for reconstructing 3D images involves a special mechanical pullback device.…”