ICE Catheter as Transesophageal Probe in Children With Congenital Heart Disease Undergoing an Electrophysiology Study.

BACKGROUND: Intracardiac echocardiography (ICE) is conventionally used as an endovascular imaging modality during electrophysiology procedures. Reports of transesophageal ICE are limited and have not included pediatric electrophysiology procedures. CASE SUMMARY: We report the first case series of transesophageal ICE (NuVision NAV) in 6 infants and young children with congenital heart disease undergoing electrophysiology studies and catheter ablation. Indications included preoperative conduction mapping and clinical arrhythmias. DISCUSSION: Transesophageal placement preserves the imaging advantages of ICE while avoiding large-bore venous access in small children without compromising image quality. The technique facilitates electroanatomic mapping by providing accurate delineation of the atrioventricular annulus in patients with complex congenital heart disease. TAKE-HOME MESSAGE: Transesophageal ICE with four-dimensional multiplanar imaging provides high-quality real-time anatomical guidance for electrophysiology procedures in infants and young children with complex congenital heart disease and may offer a practical alternative to intravascular ICE when large-bore venous access is undesirable.