An intracardiac echocardiogram (ICE) is a specialized imaging method using an ultrasound-tipped catheter to produce images from inside the heart. The catheter is inserted through the femoral vein in the groin and guided into the heart. This technique’s effectiveness is not limited by a patient’s body size or shape.
Purpose of Intracardiac Echo
Intracardiac echocardiography provides high-resolution, real-time images, serving as a detailed guide during complex, catheter-based heart procedures. This live imaging allows physicians to monitor catheter location, see cardiac structures with great clarity, and precisely maneuver instruments. The clear visualization also helps in the early detection of potential issues, like blood clots or fluid accumulation around the heart.
A common application for ICE is to guide a transseptal puncture, which involves creating a small hole in the septum between the heart’s upper chambers. ICE allows the physician to see the septum and nearby structures like the aorta, increasing the puncture’s safety.
ICE is also used during catheter ablation for arrhythmias like atrial fibrillation, helping navigate to the tissue causing the irregular rhythm. Other structural heart interventions benefit from ICE guidance, including procedures to close holes in the heart (ASD or PFO) or to implant stroke-prevention devices like the Watchman.
The Intracardiac Echo Procedure
Before the procedure, you will be instructed not to eat or drink for six to eight hours. Inform your doctor of any allergies and provide a list of all current medications. Since the procedure involves sedation, you must arrange for someone to drive you home.
The procedure occurs in a specialized room with imaging equipment. You will receive a local anesthetic to numb the insertion site in the groin and a sedative to help you relax. This sedation, or “twilight sleep,” allows you to remain conscious without feeling discomfort.
Once the area is numb, a sheath is inserted into the vein to act as a port for the ICE catheter. The catheter is then advanced through your blood vessels until it reaches the right atrium of your heart. You will not feel the catheter moving inside your body.
The physician adjusts the catheter to get the best images, which are displayed on a monitor to guide the main therapeutic procedure. The medical team will monitor you closely throughout. After the main procedure is complete, the ICE catheter is withdrawn.
Comparison with Other Echocardiograms
A transthoracic echocardiogram (TTE) is a non-invasive test where a technician moves an ultrasound probe across the chest. TTE images can be limited by obstructions like ribs and lungs, and may not provide enough detail for guiding complex interventions.
A transesophageal echocardiogram (TEE) offers clearer images by placing a probe down the esophagus, which is directly behind the heart. This eliminates the obstructions that affect TTE. However, this method can be uncomfortable, requires deeper sedation or general anesthesia, and the probe can sometimes interfere with other imaging views.
Intracardiac echo provides high-resolution images from inside the heart, avoiding external obstructions without esophageal intubation. This allows complex procedures to be performed with conscious sedation rather than the general anesthesia necessary for TEE. Avoiding general anesthesia can lead to shorter recovery times.
Recovery and Potential Complications
After the procedure, you will be monitored as medical staff apply pressure to the catheter insertion site to prevent bleeding. You will need to lie flat for a couple of hours to help the site heal. Your doctor will provide specific instructions, which include resting and avoiding strenuous activity for a few days.
Risks are generally low, with the most common issues related to the insertion site in the groin. These can include bleeding, bruising, or soreness at the puncture location. Following post-procedure instructions helps minimize these risks.
Rare but more significant complications include damage to the blood vessel or trauma to the heart wall, which could cause fluid collection (pericardial effusion). Contact your doctor if you experience excessive bleeding or swelling at the insertion site, or develop a fever.