Intracardiac Echocardiography During Interventional and Electrophysiological Cardiac Catheterization

Abstract

Just as the growing interest and proliferation of methods to reperfuse the coronary artery system with transcatheter techniques spurred interest and utilization of intracoronary ultrasound (at least in academic centers), so the growth of anatomic cardiac transcatheter interventions and increasingly aggressive transcatheter ablative strategies to treat cardiac arrhythmias has stimulated the use of and development of new methods for intracardiac echocardiography (ICE). This article will review the development, present state of the art, and applications of ICE as well as project its evolution from 2-dimensional to 3-dimensional/4-dimensional visualization and integration of therapy with imaging in the near future. It may be surprising to realize that in the earliest days of ultrasound, as early as 1956, the potential of imaging heart structures with catheter-based devices was explored.1 The earliest investigators used single-crystal probes, some of which were rotated to achieve cardiac imaging.2,3 In the mid-1960s, a mechanically rotating 4-element probe was developed by Eggleton et al,4 and in 1969, a 32-element phased-array coil was developed by Bom and coworkers5,6 in Rotterdam. These interests even preceded the development of interventional catheterization therapy. They were spurred by the problems of angiography in outlining vascular and intracardiac anatomy in large detail as single-plane and eventually biplane angiography. The goal was precise measurement of vascular lumens. Some of the early explorations of intracardiac imaging with phased-array technology and color Doppler were undertaken with miniaturized transesophageal studies in experimental animals.7 Higher-frequency rotating catheter probes in the range of 20 to 30 MHz were developed and marketed for intracoronary investigations that yielded new insights into atherosclerosis, vascular response to stents, and coronary remodeling.8 Lower-frequency (10- to 12.5-MHz) versions of these rotating single-element devices were used for the earliest intracardiac investigations by Pandian et al9 in 1990. Our efforts with an …