Intracardiac Echocardiography-Guided Interventions

SEE PAGE 1036 I t may be surprising to realize that the initial work in intracardiac echocardiography (ICE) imaging appeared in the early 1960s, preceding the development of interventional catheterization procedures (1). The increasingly sophisticated catheter-based structural interventions that have emerged over the past decade, stimulated the growth of ICE to become an established imaging modality that holds distinct advantages for use in practice such as transseptal access (2), atrial and ventricular septal defects closure (3), and radiofrequency ablation for cardiac arrhythmias (4). Furthermore, in our center, we use it exclusively to guide all congenital and structural interventional procedures. As opposed to transesophageal echocardiogram (TEE), ICE offers comparable, if not superior, imaging without the need for general anesthesia. The use of ICE also allows the interventionalist to simultaneously perform the procedure as well as the imaging part without the need of additional echocardiographic personnel. The introduction of percutaneous left atrial appendage (LAA) closure into clinical practice has stirred considerable interest to reduce the risk of thromboembolism in patients with atrial fibrillation, with several clinical trials demonstrating high procedural success rates and noninferiority to warfarin for preventing embolic stroke (5). The procedure is fairly intricate with echocardiographic guidance being an essential tool at all stages of this procedure.