Use of intracardiac echocardiography during ablation for atrial fibrillation

This chapter discusses the uses of intracardiac echocardiography (ICE) during catheter ablation procedures for atrial fibrillation (AF). Catheter ablation is an effective non-pharmacological treatment for many patients with medically refractory AF. In humans, the use of a 9 MHz rotational ICE catheter to guide transseptal puncture was studied by Daoud et al. In 53 patients undergoing radiofrequency catheter ablation, the transseptal sheath and dilator apparatus was initially positioned under fluoroscopic guidance. Intracardiac echo can also identify coagulum formation on the ablation electrode. Multiple imaging modalities are typically used to identify ablation targets before and during an AF ablation procedure. A human study found that ICE-guided AF ablation was associated with a significantly decreased incidence of severe pulmonary veins stenosis when compared to approaches that did not use ICE. Work is needed to combine ICE imaging with an ablation electrode on a single catheter.