Clinical Technology | Harbin Medical University Overcomes Anatomical Barriers in "One-Stop" Procedure Post-ASD Closure Using ICE

🔹 Clinical Background Recently, the cardiology team at The Second Affiliated Hospital of Harbin Medical University successfully performed a highly challenging "one-stop" procedure combining persistent AFib ablation and LAAC.

The core difficulty of this case lay in the patient's history of ASD closure. The remodeled intracardiac anatomy significantly increased the risk and complexity of the transseptal puncture.

🔹 Breakthrough Value of Intracardiac Imaging Facing the physical barrier and imaging artifacts caused by the metal occluder, ICE played a decisive role during the procedure.

Leveraging the high-resolution real-time imaging of ICE, the team clearly defined the anatomical relationship between the occluder edge and the lower margin of the atrial septum.

By accurately targeting a low puncture site under direct visualization, they effectively avoided damaging the existing implant and safely established left atrial access.

🔹 Green Electrophysiology & Efficient Closure During the ablation phase, the team deeply integrated ICE with a 3D navigation system, achieving a completely fluoroscopy-free "green EP" workflow to complete pulmonary vein isolation (PVI).

In the LAAC phase, based on precise anatomical measurements provided by ICE, the operators flexibly utilized a minimally invasive fixed curve sheath to deploy the occluder in a single attempt.

🔹 Strategic Insights for Complex Cases This procedure validates the irreplaceable nature of ICE combined with 3D navigation for access establishment and target intervention under complex intracardiac anatomical conditions.

Through the rational application of imaging tools and flexible switching of devices (fixed curve sheath), it provides a standardized practical paradigm for the "one-stop" combined treatment of similar complex cases.