Intracardiac echocardiography in the diagnosis and treatment of atrial fibrillation

Abstract

Intracardiac echocardiography (ICE) has become an indispensable real-time imaging modality in atrial fibrillation (AF) ablation procedures, offering distinct advantages across multiple domains, including pre-procedural exclusion of left atrial appendage (LAA) thrombus, real-time guidance for transseptal puncture, catheter localization during ablation, anatomical assessment for LAA closure, and monitoring of complications such as pericardial effusion. Recent investigations have further expanded its utility, particularly in pre-ablation LAA thrombus screening and in guiding emerging pulsed-field ablation techniques. Beyond procedural navigation, ICE enables early detection and timely management of potentially serious complications, while also substantially reducing radiation exposure during transseptal puncture. This review provides a comprehensive overview of the broadening applications of ICE in AF catheter ablation and related interventions, with a specific focus on its current roles in AF ablation and LAA occlusion. The synthesized evidence offers a valuable framework for optimizing future clinical strategies that integrate ICE into AF diagnosis and treatment. Given its considerable benefits in enhancing both safety and efficacy, the broader adoption of ICE in these procedures is strongly warranted.

Keywords

Intracardiac echocardiography / atrial fibrillation / transseptal puncture / left atrial appendage / ablation

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