Begin by inserting the intracardiac echocardiography catheter, or ICE catheter, into the femoral vein and guiding it through the inferior and superior vena cava into the right atrium. Position the ultrasound catheter in the middle of the right atrium on the short axis and rotate it clockwise, aiming the fan towards the one o'clock direction or home view to view the right atrium and right ventricle. Next, tighten the tension knob to achieve locking tension tuning.
Then turn to the home view and click anti-curvature to fully display the tricuspid annulus. Attach to the tricuspid annulus for gating training and utilize the end-breath phase modeling. From the home view, rotate clockwise towards the left atrial anterior wall to reveal the left atrial appendage.
Keep turning the catheter clockwise to the left atrium to view the left upper and lower pulmonary veins displayed as a rabbit-ear sign. Rotate to identify the anterior and posterior venous boundaries for left pulmonary vein imaging. Continue turning clockwise to the left atrium, establishing the posterior wall during which the esophagus appears as the double track sign.
Keep rotating to observe the right lower pulmonary vein displayed as a three-word sign. Turn in either direction to precisely capture the right pulmonary veins by identifying the anterior and posterior boundaries. Click on palintrope along the long axis to align the catheter tip with the coronary sinus mouth, enhancing the left atrium model.
Adjust left bend or right bend to visualize the anterior wall of the left atrium in the long-axis view. Identify and mark the critical anatomical landmarks such as pulmonary vein ostia, left atrial appendage, and other vital sites. The modeling observer scores were 3.40 plus or minus 0.81 in the ICE and 3.02 plus or minus 0.72 in the FAM groups.
The observer scores for selecting transseptal puncture sites were 4.62 plus or minus 0.73 in the ICE and 4.29 plus or minus 0.97 in the FAM groups. The pulmonary vein antrum area acquired using the ICE and FAM-based methods correlates with the area acquired by left atrial CT.However, the 95%confidence interval bias obtained using Bland-Altman analysis was narrower in ICE-acquired models than in the FAM-acquired models.
