Atrial fibrillation ablation has become a widely used technique in treating patients with atrial fibrillation in the last 20 years due to better knowledge of its pathophysiological mechanisms, evolution in techniques for isolating pulmonary veins, and reduction of complications associated with the procedure. During this period, there have been large investments in new technologies by the industry, mainly in the improvement of images such as electroanatomical mapping systems, development of new catheters and new energies to produce more effective and lasting lesions and also with the use of intracardiac echocardiography (ICE) to add safety in the performance of the procedure to the allow instant visualization of heart structures and their relationships with catheters and sheaths. ^,

The ICE is an invasive imaging technique that uses a specialized catheter to deliver ultrasound images from a probe that is located inside the heart. It presents an excellent image definition capable of recognizing in detail the location of the oval fossa and the ostia of the pulmonary veins. Allows monitoring the proper positioning and contact of the catheter tip with the structures of interest during RF application, as well as monitoring the formation of thrombi or microbubbles and alterations in tissue refraction that precede the formation of the so-called “Steam-pops”. Another advantage of the ICE is that it is operated in the field by the electrophysiologist himself, without the need for an echocardiographer.

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