USE OF INTRACARDIAC ECHOCARDIOGRAPHY DURING ELECTROPHYSIOLOGIC EVALUATION AND THERAPY OF ATRIAL ARRHYTHMIAS

Intracardiac Ultrasound for Atrial Arrhythmias. The relationship betwe en endocardial anatomy and the substrate for a variety of atrial arrhy thmia mechanisms is being increasingly appreciated, By using intravasc ular ultrasound imaging systems in the cardiac chambers, direct endoca rdial visualization can be provided, The advantages include: precise a natomic localization of the ablation catheter tip in relation to impor tant endocardial structures that cannot be visualized with fluoroscopy ; the ability to guide ablative procedures partly, or in some instance s entirely, by anatomic landmarks; potential reduction in fluoroscopy time; evaluation of stability of catheter tip-tissue contact; confirma tion of lesion formation and identification of lesion size and continu ity; immediate identification of complications such as clot and perica rdial effusion; assistance in the guidance of transseptal puncture; an d as a research tool to help in understanding the critical role played by specific endocardial structures in atrial arrhythmogenesis, Presen tly, intracardiac echocardiography (ICE) is useful as an adjunct in gu iding mapping and ablation of focal atrial tachycardia, In our laborat ory, it has significant advantage in modification or ablation of sinus node function in patients with inappropriate sinus tachycardia syndro me. Its use in helping to guide ablation of atrial fibrillation remain s an exciting, but largely unproved, hypothesis. Better technology wil l be required if widespread clinical use of ICE is to occur.