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Trends and Advancements in 

Intra-cardiac Echo Imaging Systems

Ultrasound
ICE

Intra-cardiac Echocardiography (ICE) uses catheter-based cardiac ultrasound array to image anatomy and devices inside the heart to help guide procedures. ICE is primarily used in electrophysiology (EP) lab ablation procedures and transcatheter structural heart interventions.

Both transthoracic (TTE) and transesophageal echocardiography (TEE) are used for guiding transcatheter interventions, but they have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with TEE. But, limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs and a learning curve for new operators.[1]

ICE can be helpful in guiding transseptal punctures for both EP lab and structural heart device transseptal punctures (including left atrial appendage occlusions), transcatheter aortic valve replacement (TAVR), transcatheter mitral valve repair (TMVR), and transcatheter closure of paravalvular leak (PVL), patent ductus arteriosus (PDA), atrial septal defects (ASD), ventricular septal defect (VSD), and patent foramen ovale (PFO).[2]

ICE has been widely adopted in the EP lab to guide transseptal punctures due to its ability to define atrial septal anatomy and provide visualization of transseptal catheter position in relation to other structures within the heart.[3]