Intracardiac Echocardiography to Guide Structural Heart Disease Interventions-Dr. Wang slides

Dr. Wang slides

Pdf Summary

This presentation by Dr. Dee Dee Wang addresses the implementation of intracardiac echocardiography (ICE) in clinical practice, focusing on its cost, value, clinical setup, and administrative key performance indicators (KPIs). ICE, an advanced imaging modality used especially during transcatheter interventions, provides real-time, detailed cardiac visualization, enabling safer and more precise procedures, notably for complex cases such as tricuspid regurgitation and left atrial appendage (LAA) management.<br /><br />A major challenge highlighted is the under-valuation and poor branding of ICE compared to other interventional devices like the Impella pump, despite its critical clinical utility. Traditional billing models do not reflect the complexity or technical demands of ICE imaging, which leads to physician productivity being undervalued. This discrepancy affects institutional motivation to adopt and invest in ICE technology despite its proven clinical benefits.<br /><br />Operationalizing ICE requires specific imaging equipment, compatible catheters (2D or 3D depending on the procedure), appropriate anesthesia, and a skilled multidisciplinary team including imaging physicians well-trained in ICE. Administrative support from schedulers and vendor technical assistance is also essential. Proper shielding and room setups are needed to ensure operator safety during procedures involving radiation and fluoroscopy.<br /><br />Economically, ICE impacts length of stay and procedural costs, with staff and equipment representing major cost drivers. Centers with existing CT capabilities are better positioned to scale ICE use. However, staffing constraints currently limit the ability to meet the increasing clinical demand for ICE.<br /><br />Dr. Wang advocates for a rebranding of ICE to better capture its value and complexity, as the current term "echo" under-represents both the device and the expert imaging required. Successful ICE implementation hinges on team alignment, system-wide financial integration, and better recognition of imaging physicians’ contributions to advanced cardiac interventions.

Keywords

Intracardiac Echocardiography

ICE implementation

Clinical practice

Cost and value

Transcatheter interventions

Tricuspid regurgitation

Left atrial appendage management

Physician productivity

Multidisciplinary team

Healthcare economics