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Left atrial appendage occlusion using intracardiac echocardiography
Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative prevention strategy for patients with nonvalvular atrial fibrillation and contraindications to long-term anticoagulation.1 In randomized trials studying the Watchman device (Boston Scientific, St. Paul, MN), implantation was performed under transesophageal echocardiography (TEE) guidance.1 The use of TEE often mandates the presence of general anesthesia and an additional cardiologist or anesthesiologist to perform TEE. This uses greater health care resources and adds additional complexity to the procedure.How to use intracardiac echocardiography to guide catheter ablation of outflow tract ventricular arrhythmias
The anatomy of the ventricular outflow tracts and semilunar valves as it pertains to catheter ablation of outflow tract ventricular arrhythmias (OTVAs) has been described.1 Assessment of semilunar valve and regional anatomy by fluoroscopy and angiography has limitations. Coronary arteries may be subject to damage from catheter ablation near the semilunar valves due to their proximity to sites of origin of OTVAs. Detailed intracardiac echocardiographic (ICE) views of the semilunar valves may be useful to understand the anatomy, catheter location, and coronary artery proximity and variations.Fluoroless catheter ablation of atrial fibrillation
Although the concept of performing fluoroless catheter ablation of atrial fibrillation (AF) was introduced several years ago, it has yet to gain wide adoption.1,2 Despite its well-documented advantages, there are several impediments, including concern that a fluoroless approach will add time to the procedure and may require a second operator. However, perhaps the greatest obstacle is that many electrophysiologists are trained to rely on fluoroscopic imaging and are therefore reluctant to trust intracardiac echocardiography (ICE) as their primary visual modality for tracking catheter movement and manipulation.
