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Intracardiac echocardiography in complex cardiac catheter ablation procedures

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Abstract

With the availability of catheter ablation for the elimination of complex cardiac arrhythmias, new imaging tools have enhanced the safety and efficacy of procedures performed in the electrophysiology laboratory. We review the use of intracardiac ultrasound (ICE) as the modality that allows real-time monitoring and reconstruction of cardiac anatomy. Practical technical information related to the use of ICE in ablation procedures in general and particular aspects related to ablation of atrial fibrillation, atrial flutter, ventricular tachycardia, and arrhythmias in adults with congenital heart disease are discussed in this manuscript.

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Authors and Affiliations

  1. Penn State Heart and Vascular Institute, Penn State University College of Medicine, 500 University Drive, H047, Hershey, PA, 17033, USA

    Javier E. Banchs, Parag Patel, Gerald V. Naccarelli & Mario D. Gonzalez

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  1. Javier E. Banchs
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  2. Parag Patel
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  3. Gerald V. Naccarelli
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  4. Mario D. Gonzalez
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Correspondence to Javier E. Banchs.

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Intracardiac echocardiography demonstrating the reposition of the lasso catheter from the left inferior to the left superior pulmonary vein (AVI 54003 kb)

A thrombus attached to the tip of the transseptal sheath is shown. An externally irrigated tip catheter is seen through the sheath. The ICE catheter is lying against the fossa ovalis oriented towards the left pulmonary veins to intersect the distal end of the ablation catheter and transseptal sheath. Intravenous heparin had been already given. The catheter was withdrawn followed by forceful aspiration from the side port of the transseptal sheath. The procedure was resumed, regaining transseptal access after the transseptal apparatus was pulled back to the right side and flushed (AVI 54003 kb)

Intracardiac echocardiography for guidance and monitoring of ventricular tachycardia ablation, demonstrating an area of dense myocardial scar and akinesis in the mid-inferolateral-wall of the left ventricle (AVI 54003 kb)

Intravenous ultrasound contrast administered during intracardiac echocardiography to evaluate for left ventricular thrombus prior to ablation for ischemic ventricular tachycardia (AVI 54003 kb)

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Banchs, J.E., Patel, P., Naccarelli, G.V. et al. Intracardiac echocardiography in complex cardiac catheter ablation procedures. J Interv Card Electrophysiol 28, 167–184 (2010). https://doi.org/10.1007/s10840-010-9474-8

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