Intracardiac Echocardiography in Contemporary Electro-Physiology: The Imaging Engine Behind the Fluoroless ERA
Abstract
Intracardiac echocardiography (ICE) has evolved from an adjunct procedure to a major imaging component of contemporary electrophysiology (EP) and is transforming the assessment of complex ablation and device cases. This growth corresponds to an inflection point for EP practice in response to converging pressures: an interest in improving safety and efficiency in EP procedures, an ever-increasing trend toward minimal or zero fluoroscopy procedures, and a commensurate development of catheter technology and image integration. ICE specifically meets all of these demands by providing high-resolution intracardiac images through conscious sedation techniques and decreasing ionizing radiation exposure.
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9. Berti S, Pastormerlo LE, Rezzaghi M, et al. Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage closure. EuroIntervention. 2021;16:1286-94.
10. Alkhouli M, Rihal CS. Concomitant atrial fibrillation ablation and left atrial appendage closure: rationale, technique, and outcomes. Heart Rhythm. 2022;19:1765-72.
11. Brugada J, Katritsis DG, Arbelo E, et al. Intracardiac echocardiography in pediatric and congenital cardiac electrophysiology. Europace. 2024;26:euae047.
12. Zhang Y, Li X, Chen M, et al. Intracardiac echocardiography improves lesion quality and procedural efficiency during pulmonary vein isolation. Front Cardiovasc Med. 2025;12:1612181.
13. Gutiérrez M, Wang Y, Silva J, et al. Intracardiac echocardiography: technology update and clinical applications. Cardiovasc Ultrasound. 2015;13:38.
14. Smith T, Patel N, Rogers T, et al. Expanding role of intracardiac echocardiography in congenital and structural interventions. JACC Cardiovasc Interv. 2025;18:1123-35.
2. Demo H, Aranda C, Razminia M, et al. Fluoroless left atrial access for radiofrequency and cryoballoon ablation of atrial fibrillation. J Interv Card Electrophysiol. 2022;63:423-31.
3. Razminia M, Zei P. Intracardiac Echocardiography: A Handbook for Electrophysiologists. Minneapolis (MN): Cardiotext Publishing; 2022.
4. Li X, Zhang Y, Chen M, et al. Intracardiac echocardiography: an invaluable tool in electrophysiology procedures. Front Cardiovasc Med. 2024;11:1357924.
5. Debreceni D, Kuck KH, Ouyang F, et al. Zero-fluoroscopy catheter ablation for atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1178783.
6. Preda A. The fluoroless future in electrophysiology: a state-of-the-art review. Diagnostics (Basel). 2024;14:412.
7. Regoli F, Caputo ML, Conte G, et al. Intracardiac echocardiography during transvenous lead extraction: procedural impact and safety. Europace. 2019;21:1064-71.
8. Alkhouli M, Hijazi ZM, Holmes DR Jr, et al. Intracardiac echocardiography–guided left atrial appendage occlusion. JACC Cardiovasc Interv. 2020;13:2779-90.
9. Berti S, Pastormerlo LE, Rezzaghi M, et al. Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage closure. EuroIntervention. 2021;16:1286-94.
10. Alkhouli M, Rihal CS. Concomitant atrial fibrillation ablation and left atrial appendage closure: rationale, technique, and outcomes. Heart Rhythm. 2022;19:1765-72.
11. Brugada J, Katritsis DG, Arbelo E, et al. Intracardiac echocardiography in pediatric and congenital cardiac electrophysiology. Europace. 2024;26:euae047.
12. Zhang Y, Li X, Chen M, et al. Intracardiac echocardiography improves lesion quality and procedural efficiency during pulmonary vein isolation. Front Cardiovasc Med. 2025;12:1612181.
13. Gutiérrez M, Wang Y, Silva J, et al. Intracardiac echocardiography: technology update and clinical applications. Cardiovasc Ultrasound. 2015;13:38.
14. Smith T, Patel N, Rogers T, et al. Expanding role of intracardiac echocardiography in congenital and structural interventions. JACC Cardiovasc Interv. 2025;18:1123-35.
| Files | ||
| Issue | Vol 20 No 4 (2025) | |
| Section | Editorial | |
| Keywords | ||
| Electrophysiology Fluoroless Ablation Intracardiac Echocardiography | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Admin T, Demo H, Razminia M. Intracardiac Echocardiography in Contemporary Electro-Physiology: The Imaging Engine Behind the Fluoroless ERA. Res Heart Yield Transl Med. 2026;20(4):255-258.
