Intracardiac echocardiography from the left heart chambers to guide electrophysiology procedures

Intracardiac echocardiography (ICE) has evolved into an integral imaging modality in contemporary electrophysiology, providing real-time visualization that enhances both the safety and efficacy of complex procedures. Although most operators rely exclusively on imaging windows obtained from the right atrium and right ventricle, this may limit comprehensive assessment of left cardiac structures. This review examines the emerging role of ICE imaging directly from the left atrium (LA) and left ventricle via transseptal access, with a focus on technical and practical considerations, highlighting catheter positioning, imaging views, and relevant anatomic relationships. In addition, we discuss the applications of LA/left ventricular ICE to guide left-sided electrophysiology procedures, including ablation of atrial and ventricular arrhythmias and LA appendage occlusion.