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Intracardiac Echocardiogram

Intracardiac Echocardiography (ICE) is a cardiac imaging technology that works by sending harmless sound waves from an instrument called a transducer. The echo transducer is at the tip of a cathetera thin, flexible tube inserted through a puncture into the blood vessel near the groin.

The catheter is threaded through this blood vessel to the heart, where the sound waves create a moving image inside the heart. It shows heart valves and heart structures in detail.

Common uses for ICE:

  • Heart biopsy: If your doctor is taking heart tissue for a biopsy, the catheter will usually be placed in the vein in your neck. A catheter with a small, jaw-like tip will snip off a small sample of tissue.

  • Repairing heart defects: If your doctor is closing a heart defect like a hole in your heart, you will probably have catheters inserted in both the arteries and veins of the groin and neck. A device is then inserted into your heart to close the hole.

  • Cardiac ablation: If you have an abnormal heartbeat, multiple catheters are placed in the arteries and veins of your groin or neck so that energy can scar the part of your heart that is causing the irregular electrical signals.

There are some major benefits to using ICE:

  • You do not need to be asleep.

  • It reduces radiation exposure.

  • It provides real-time feedback during the procedure.

  • It takes less time than other similar diagnostic methods.

  • It provides continuous monitoring for problems during the procedure.

  • It provides clear images of tumors and surrounding areas for better accuracy.

  • It is not limited by factors like obesity, emphysema, a patient’s position and breathing.

Who is eligible for an intracardiac echocardiogram?

ICE is an ideal imaging tool to support the following procedures:

  • Mitral valve repair.

  • Biopsy of cardiac tumors.

  • Left atrial appendage closure.

  • Catheter ablation of cardiac arrhythmias.

  • Transcatheter aortic valve replacement (TAVR).

  • Surgical closure of atrial septal defects (ASD), patent foramen ovale (PFO), and ventricular septal defects (VSD).

What conditions can be diagnosed by an intracardiac echocardiogram?

ICE can diagnose:

  • Cardiac tumor: A tumor of the heart.

  • Cardiomyopathy: An enlargement of the heart.

  • Atherosclerosis: A gradual blocking of the arteries by fatty substances and other materials in the bloodstream.

  • Congenital heart disease: Defects in one or more heart structures that occur during the fetus's formation, such as a ventricular septal defect.

  • Heart failure: A condition in which the heart muscle has become weakened or stiff.

  • Aneurysm: A widening and weakening of a part of the heart muscle or the aorta (a major artery).

  • Heart valve disease: Malfunction of one or more of the heart valves.

  • Pericarditis: An inflammation or infection of the sac that surrounds the heart.

  • Pericardial effusion or tamponade: The sac around the heart can become filled with fluid, blood, or infection. This can compress the heart muscle.

  • Atrial or septal wall defects: Irregular channels between the right and left sides of the heart may be present at birth.

  • Shunts: Shunts can be seen in atrial and ventricular septal defects but also when irregular blood flow is pushed through the circulation from the lungs and liver.

How do I prepare for an intracardiac echocardiogram?

  • You will be given instructions about what to eat and drink during the 24 hours before the test. You may be asked not to eat or drink for six to eight hours before the procedure.

  • Tell your doctor or nurse if you are allergic to anything, especially iodine, shellfish, latex or rubber products, medicines like penicillin, or X-ray dye.

  • Tell your doctor about any medications that you are taking. It's possible that your doctor will want you to stop taking them for some period of time before the procedure.

  • If you usually wear a hearing aid, it's best to wear it during the procedure. If you wear glasses, bring them.

  • Plan to have someone drive you home after your procedure.

What should I expect during my intracardiac echocardiogram?

ICE is done in a procedure room with special X-ray and imaging machines. It is usually performed while you're awake.

Before the catheter is inserted into your vein, you'll be given a shot of anesthetic to numb the area.

After you feel numb, the catheter will be inserted into an incision. A plastic sheath will first be inserted into the incision. This will allow your doctor to insert the catheter.

The catheter goes through your veins to reach your heart. Its tip is placed in the heart's right atrium (RA). The operator can adjust the catheter to get the best images.

Threading the catheter shouldn't be painful, and you shouldn't feel it moving through your body, but tell your doctor if you have any discomfort.

Why choose Presbyterian for an intracardiac echocardiogram?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options, including lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.