SCAI releases comprehensive roadmap for intracardiac echocardiography in structural heart disease

The Society for Cardiovascular Angiography & Interventions (SCAI) has published a comprehensive roadmap that details the use of intracardiac echocardiography (ICE) to guide structural heart disease (SHD) interventions for clinicians. ICE represents a significant departure from the traditional reliance on transesophageal echocardiography (TEE) by providing clinicians with real-time, high-resolution imaging from inside the heart without the need for general anesthesia. 

Published in JSCAI, "SCAI Position Statement on Intracardiac Echocardiography to Guide Structural Heart Disease Interventions" examines the advantages, limitations, and best practices for ICE, which is increasingly being integrated into procedures such as mitral, tricuspid, and pulmonary valve interventions, as well as left atrial appendage closure (LAAC), atrial septal defect (ASD), and patent foramen ovale (PFO) closure. 

"This technology is revolutionizing the way transcatheter procedures are performed. ICE has matured from a niche tool into a frontline technology for guiding structural interventions," said Mackram F. Eleid, MD, FSCAI, Chair of the writing group and interventional cardiologist at Mayo Clinic. "This is not just about better imaging. It is about better outcomes. ICE allows us to avoid general anesthesia, reduce complications, and, in many cases, discharge patients the same day. For patients, this means a safer and less invasive experience. For clinicians, it means more precision and confidence during complex procedures. The statement reflects an international consensus that ICE is ready to be widely adopted." 

The document provides standardized ICE imaging protocols and views tailored to specific interventions, offering operators a structured approach to integrating ICE into their practice. It emphasizes training pathways for physicians, the need for workflow redesign within cath labs, and institutional readiness to ensure safe and effective implementation. 

ICE is more than an alternative to TEE. It is changing how we think about structural heart care. By eliminating the need for general anesthesia in many cases, ICE makes procedures possible for patients who might otherwise be turned away due to frailty or comorbidities. It also streamlines scheduling, reduces the burden on anesthesia teams, and improves efficiency in the cath lab. With advancing technology and the right training, ICE has the potential to become the default imaging modality for some structural interventions in the years ahead." 

Omar K. Khalique, MD, FSCAI, Co-Chair of the writing group and Director of Cardiovascular Imaging at St. Francis Hospital & Heart Center

Beyond protocols and workflows, the statement highlights ongoing barriers to adoption, particularly those related to reimbursement, as current coding does not fully account for the complexity of ICE-guided procedures or the role of interventional imaging specialists. The writing group urged policymakers to update reimbursement models so that hospitals and physicians are appropriately supported in offering ICE. The position statement also called for further comparative studies of ICE and TEE, particularly in mitral and tricuspid interventions, where evidence is still emerging.