Intravascular echocardiography (ICE) is an imaging technique that incorporates a miniature ultrasound transducer on the tip of a catheter, which is inserted through a blood vessel and positioned inside the heart or major vessels. This provides high-resolution real-time images of cardiac structures from within. Unlike transthoracic or transoesophageal echocardiography, ICE provides a view from inside the heart itself without requiring an external operator or a probe in the oesophagus.
ICE is used primarily to guide complex interventional and electrophysiological procedures in the cardiac catheterisation laboratory. It allows the operator to visualise anatomical structures, monitor catheter positions, and assess procedure results in real time without general anaesthesia. Its most common applications include guiding transseptal puncture (crossing from the right to the left atrium through the atrial septum, required for left-sided ablation and structural interventions), monitoring catheter ablation procedures for atrial fibrillation, and guiding structural procedures such as left atrial appendage occlusion and septal defect closure.
Advantages of ICE over transoesophageal echocardiography (TOE) include the ability to use it with the patient awake (avoiding general anaesthesia or heavy sedation), no radiation exposure, and continuous imaging throughout a procedure without an additional operator. The main limitation is cost.
ICE is a specialised technique performed in high-volume electrophysiology and structural heart centres.
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