Beat to beat 3-dimensional intracardiac echocardiography: theoretical approach and practical experiences

Three-dimensional (3D)-imaging provides important information on cardiac anatomy during electrophysiological procedures. Real-time updates of modalities with high soft-tissue contrast are particularly advantageous during cardiac procedures. Therefore, a beat to beat 3D visualization of cardiac anatomy by intracardiac echocardiography (ICE) was developed and tested in phantoms and animals. An electronic phased-array 5-10 MHz ICE-catheter (Acuson, AcuNav/Siemens Medical Solutions USA/64 elements) providing a 90° sector image was used for ICE-imaging. A custom-made mechanical prototype controlled by a servo motor allowed automatic rotation of the ICE-catheter around its longitudinal axis. During a single heartbeat, the ICE-catheter was rotated and 2D-images were acquired. Reconstruction into a 3D volume and rendering by a prototype software was performed beat to beat. After experimental validation using a rigid phantom, the system was tested in an animal study and afterwards, for quantitative validation, in a dynamic phantom. Acquisition of beat to beat 3D-reconstruction was technically feasible. However, twisting of the ICE-catheter shaft due to friction and torsion was found and rotation was hampered. Also, depiction of catheters was not always ensured in case of parallel alignment. Using a curved sheath for depiction of cardiac anatomy there was no congruent depiction of shape and dimension of static and moving objects. Beat to beat 3D-ICE-imaging is feasible. However, shape and dimension of static and moving objects cannot always be displayed with necessary steadiness as needed in the clinical setting. As catheter depiction is also limited, clinical use seems impossible.