Utility of intracardiac echocardiography (ICE) in electrophysiology: ICEing the CAKE (Catheter ablation knowledge enhancement)

Purpose. Previous studies have demonstrated the utility of intracardiac ech ocardiography (ICE) during electrophysiologic procedures including radiofre quency catheter ablation. The purpose of this study was to analyze the init ial learning experience with ICE during invasive electrophysiologic procedu res. Methods. During a 1-month ICE trial, patients scheduled for radiofrequency catheter ablation underwent concurrent imaging using a 9 French, 9 MHz cath eter in the right atrium proximal to important endocardial structures and d iagnostic/ablation catheters. The procedure length, fluoroscopy and ICE tim es were systematically recorded during each procedure. In addition, the ima ges were analyzed and recorded and their utility was evaluated after each c ase. A case control analysis was also performed. Results. Seven patients underwent ICE (as part of an ICE trial period) duri ng their electrophysiology study between July 21 and August 13, 1998. This study demonstrated the utility of ICE in identifying radiofrequency cathete r tip stability and intracardiac and endocardial structures, including the crista terminalis, coronary sinus, and foramen ovale. Conclusion. ICE contributes to the electrophysiology arsenal for both diagn ostic and therapeutic procedures. In particular, this technique demonstrate d a decrease in fluoroscopy time as compared to a case control population. This technique limits radiation to the patient and operator. In addition, e ndocardial structures, which may be pivotal in diagnosing and treating card iac arrhythmias, were easily identified. Radiofrequency catheter stability can also be assessed,vith this technique.