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Milestones in Intracardiac Echocardiography

A history of innovations in Intracardiac Echocardiography (ICE) from Siemens Healthineers

AcuNav Volume

Intracardiac Echocardiography (ICE) uses catheter-based cardiac ultrasound to image anatomy. The catheter is threaded through a venous or, less frequently, arterial sheath to the heart. The sound waves create a detailed moving image inside the heart to view the heart valves and structures. Electrophysiology (EP) lab ablations procedures and transcatheter structural heart interventions are the primary uses for ICE.

Transesophageal echocardiography (TEE) has been the standard for guiding structural heart interventions; however, intracardiac echocardiography (ICE) has some advantages. The primary benefit of ICE over TEE is that it does not require general anesthesia or intubation but can be performed on an awake patient. Bypassing the need for general anesthesia can reduce hospital stays and the associated risks of esophageal intubation.

ACUSON (later Siemens Healthineers) was the first to introduce a phased array ICE catheter. Over 20 years later, with over 2 million procedures completed, Siemens Healthineers continues to work with clinicians to innovate in the space of intracardiac echocardiography.  

AcuNav 10F

In 2000, the first ACUSON AcuNav 10 French catheter was introduced to the market. This was the first phased array intracardiac echocardiography (ICE) catheter. It enabled improved visualization for heart applications in electrophysiology and interventional cardiology.

AcuNav 8F

In 2004, ACUSON introduced the smaller 8 French catheter to better meet the pediatric interventionalist's needs.

Biosense Webster

In 2006, Siemens Healthineers partnered with Biosense Webster, A Johnson & Johnson Company (leading manufacturer of electrophysiology mapping equipment and therapeutic & diagnostic catheters) to further advance the ACUSON AcuNav catheter into the area of imaging during EP procedures.

CartoSound EP mapping

2007 brought the introduction of the SoundStar® catheter. This technology integrated the ACUSON AcuNav catheter technology with sensor technology to enable EP mapping technology, which accurately places data sets from the 2D ICE image into the X Y Z planes, creating three-dimensional images of the heart chambers. The CartoSound® technology (a Siemens Healthineers/BWI collaboration)1 is a differentiating technology in electro-anatomical mapping.


In 2012, Siemens Healthineers introduced the first real-time volume ICE catheter, the ACUSON AcuNav V catheter. The catheter was a 90° x 24° imaging catheter created to address the imaging needs of the structural heart environment where cross-sectional views of the valve orifices are required to visually guide valve repair and replacement procedures.

ACUSON AcuNav Volume ICE

In 2017, Siemens Healthineers received FDA clearance for the ACUSON AcuNav Volume ICE catheter, the next generation of volume (4D) ICE catheter imaging. The catheter brings a broader elevation plane than the ACUSON AcuNav V catheter and provides PW, CW, and color Doppler capabilities in both 2D and 4D imaging modes.

ACUSON AcuNav Volume 4D ICE

In 2022, working closely with customers, Siemens Healthineers continued the tradition of innovation and released an updated version of the AcuNav Volume 4D ICE catheter – with an improved imaging approach.

This case of left atrial appendage occlusion (LAAO) with a Watchman device (Boston Scientific) demonstrates the advantages of using the ACUSON AcuNav Volume ICE Catheter over transesophageal echocardiography (TEE) and 2D ICE.

A 38 year old female with significant osteogenesis imperfecta, severe scoliosis and severe myxomatous mitral valve insufficiency from bileaflet prolapse was referred for MitraClip. She had an additional history of COPD with CO2 retention and obstructive sleep apnea. She had been experiencing dyspnea, consistent with NYHA III symptoms.

An adult TEE transducer could not be advanced due to the severe scoliosis and pediatric TEE imaging was suboptimal for use in the procedure. TTE, fluoroscopy and volume ICE were used to successfully deploy a MitraClip.