Intracardiac echocardiography during invasive electrophysiological procedures. A scientific statement of the European Heart Rhythm Association of the ESC, and the European Association of Percutaneous Cardiovascular Interventions of the ESC

Intracardiac echocardiography (ICE) is an imaging technique that provides real-time, detailed visualisation of intracardiac structures during various interventional procedures performed in the electrophysiology laboratory. Over the past decades, ICE has evolved beyond simply assisting with transseptal puncture, becoming an auxiliary tool in numerous aspects of cardiac interventions. This scientific statement offers a comprehensive, systematic overview of current applications of ICE across different clinical scenarios. The existing evidence regarding the benefits of ICE is primarily derived from observational studies, which complicates the formulation of definitive advice for its clinical use. Thus, this document aims to serve as a practical roadmap, emphasising the key benefits of the technique. The document covers fundamental principles of ICE imaging, standardised views, its role in transseptal puncture, ablation of supraventricular and ventricular arrhythmias, reduction of procedural radiation, early detection and management of periprocedural complications, identification of infective endocarditis, and the role of ICE for endomyocardial biopsy and left atrial appendage occlusion procedures.