Intracardiac Echocardiography in Structural Heart Interventions: A Comprehensive Overview.

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Technology

Background:

• Intracardiac echocardiography (ICE) offers high-resolution, real-time visualization within cardiac chambers.
• Initially for electrophysiology, ICE is now vital for diverse structural heart interventions.

Purpose of the Study:

• To review the current applications and technical principles of ICE in structural heart interventions.
• To compare ICE with other imaging modalities like TEE and fluoroscopy.
• To explore future advancements in ICE technology and its integration into cardiac procedures.

Main Methods:

• Review of current literature, clinical studies, and registries on ICE utilization.
• Analysis of technical aspects including catheter design, imaging protocols, and 3D ICE.
• Comparative assessment of ICE against transesophageal echocardiography (TEE) and fluoroscopy.

Main Results:

• ICE supports a wide range of structural interventions, including ASD/PFO closure, LAAO, TEER, and valve therapies.
• It enables precise device navigation and intra-procedural monitoring in minimally invasive procedures.
• Recent data indicate good safety, feasibility, and procedural outcomes with ICE.

Conclusions:

• ICE is a valuable tool for structural heart interventions, enhancing procedural precision and supporting sedation-sparing approaches.
• Future directions include 3D imaging, fusion imaging, AI, and robotics to further optimize ICE applications.
• Operator experience and workflow integration are key practical considerations for widespread ICE adoption.