Steph Jasa
Feb 244 min
Intracardiac echocardiography has found applications in various EP procedures, including atrial fibrillation ablation, ventricular tachycardia mapping, and left atrial appendage closures. Ongoing research aims to refine these technologies further, with a focus on improving image resolution, reducing catheter sizes, and expanding the scope of diagnostic capabilities.
Optimizing ICE images, whether in 2D or 4D, is crucial for accurate visualization during cardiac electrophysiology procedures. Remember, the optimization of intracardiac images is a dynamic process that may vary based on the patient's anatomy, the specific procedure, implanted devices (i.e., pacing leads or prosthetic valve), and the imaging system used. Regular training and communication within the healthcare team are essential for maximizing the benefits of these advanced imaging modalities.
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Keep reading for some general tips and tricks for optimizing both imaging modalities!
Catheter Positioning: “Be the beam!” Think in 3D – Use the 3D heart in your brain to think about “where you are and where you want to be.” Are you too high? Do you need to “clock” the transducer?
Gain Adjustment: Adjust the gain settings to optimize image brightness and contrast. Be cautious not to set the gain too high, as it may lead to excessive noise in the image.
Depth Adjustment: Set the imaging depth appropriately to focus on the area of interest. This prevents unnecessary visualization of structures outside the target region and improves resolution.
Frequency Selection: Select the appropriate frequency for the transducer based on the depth of the structures you are visualizing. Higher frequencies offer better resolution for superficial structures.
Frame Rate: Optimize the frame rate to ensure smooth real-time imaging. Higher frame rates enhance the ability to observe dynamic structures and catheter movements.
Artifact Recognition: Familiarize yourself with common artifacts such as reverberation and shadowing. Understanding artifacts helps in differentiating them from actual anatomical structures.
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Volume Rate Adjustment: Adjust the volume rate to balance image quality and data processing speed. Higher volume rates may provide smoother real-time 4D imaging but could require more processing power.
Slice Thickness: Optimize the slice thickness to balance image detail and data volume. Thinner slices provide higher resolution but may generate larger datasets.
Rotation and Orientation: Experiment with rotating and orienting the 4D volume to obtain the most informative views. This is particularly helpful for visualizing complex anatomies and catheter trajectories.
Color Doppler Integration: Use color Doppler to enhance visualization of blood flow within the heart chambers. Adjust color gain and scale to optimize the representation of flow patterns.
Dynamic Rendering: Take advantage of the dynamic rendering capabilities of 4D imaging. This feature allows you to visualize moving structures in real-time, providing a more comprehensive understanding of cardiac dynamics.
Artifact Management: Recognize and manage artifacts unique to 4D imaging, such as stitching artifacts or irregularities in volume rendering. Familiarity with these artifacts will aid in accurate interpretation.
Collaboration with the Team: Collaborate with the electrophysiology team to coordinate catheter movements and positioning with the imaging plane for optimal visualization.
Continuous Training: Regularly train and update the medical team on the optimal use of intracardiac ultrasound. Familiarity with the equipment and techniques contributes to efficient and accurate imaging.
Documentation: Document key findings during the procedure for reference and future analysis. Clear documentation aids in decision-making and post-procedural assessments.
The integration of ICE, especially with the advent of 4D ICE technology, is revolutionizing cardiac electrophysiology procedures. These advancements contribute to safer, more precise interventions, ultimately improving patient outcomes. As technology continues to evolve, the collaboration between innovation and clinical expertise will undoubtedly drive further breakthroughs in the field of intracardiac imaging, ushering in a new era of cardiac care.
Are you inspired to take a closer look at the medical imaging used in Cardiac Electrophysiology procedures? The CHART course, Radiology & EP Imaging: Do You See What I See? is a great place to start with lessons covering fluoroscopy, ultrasound, and 3D mapping concepts. This course includes radiation biology and protection parameters.
REFERENCES:
1. Intracardiac Ultrasound in Cardiac Electrophysiology:
C. P. Teijeiro-Mestre, et al. "Intracardiac Echocardiography in the Real World: Procedural and Clinical Outcomes." JACC Cardiovasc Imaging. 2017;10(2):185-194.
Reddy VY, Neuzil P. "Cardiac Imaging for Ablation of Atrial Fibrillation." Eur Heart J. 2014;35(22):1473-1479.
2. 4D ICE Technology:
Bala Ramanan, Vivek Y. Reddy, and David L. Pisoni, "Intracardiac Echocardiography: A Comprehensive Review." JACC Cardiovasc Interv. 2014;7(6):663-672.
Use of a novel 4D intracardiac echocardiography catheter to guide interventional electrophysiology procedures. R.M. Kaplan MD, MS, et al., Journal of Cardiovascular Electrophysiology, https://doi.org/10.1111/jce.15251
3. Clinical Applications and Future Directions:
C. P. Teijeiro-Mestre, et al. "Intracardiac Echocardiography in the Real World: Procedural and Clinical Outcomes." JACC Cardiovasc Imaging. 2017;10(2):185-194
R. J. Holmes, "New Imaging Techniques in Electrophysiology: Intracardiac
Echocardiography." J Cardiovasc Electrophysiol. 2005;16(9):1015-1019.
Steph Jasa
MA, MHA, CEPS, RCES, RCIS
Steph serves as the #chiefNERD for the CHART team. She has more than 20 years of experience in cardiology, including time in the hospital setting, industry, and consulting for cardiology companies. Her passion for providing education and training is underpinned by a desire to take complex concepts and make them easy to understand and apply in the clinical setting.
Connect with Steph on LinkedIn for information about CHART Healthcare Academy, Cardiac Electrophysiology and Cardiac Device Clinic training and education programs.
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