How to use intracardiac echocardiography to guide catheter ablation of outflow tract ventricular arrhythmias

The anatomy of the ventricular outflow tracts and semilunar valves as it pertains to catheter ablation of outflow tract ventricular arrhythmias (OTVAs) has been described. 1 Asirvatham S.J. Correlative anatomy for the invasive electrophysiologist: outflow tract and supravalvar arrhythmia. J Cardiovasc Electrophysiol. 2009; 20: 955-968 Crossref PubMed Scopus (114) Google Scholar Assessment of semilunar valve and regional anatomy by fluoroscopy and angiography has limitations. Coronary arteries may be subject to damage from catheter ablation near the semilunar valves due to their proximity to sites of origin of OTVAs. Detailed intracardiac echocardiographic (ICE) views of the semilunar valves may be useful to understand the anatomy, catheter location, and coronary artery proximity and variations. 2 Enriquez A. Saenz L.C. Rosso R. et al. Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it. Circulation. 2018; 137: 2278-2294 Crossref PubMed Scopus (104) Google Scholar We describe in detail the application of ICE for this purpose during catheter ablation of OTVAs.