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Figure 1. Schematic overview of the core clinical applications of intracardiac echocardiography (ICE) in atrial fibrillation ablation and left atrial appendage closure procedures. (A) Transseptal puncture (TSP) guidance. ICE provides real-time high-definition visualization of the interatrial septum (IAS) and fossa ovalis, enabling safe puncture even in complex anatomies (e.g., thickened septum or atrial septal aneurysm) by clearly visualizing the tenting effect, with the potential to reduce or eliminate fluoroscopy exposure. (B) Stepwise procedural guidance. Top panel: Direct visualization of catheter-tissue contact, microbubble formation, and linear lesion accuracy during pulmonary vein (PV) isolation. Middle panel: Target and anatomical assessment for TSP, including precise trajectory planning and accurate sizing of the left atrial ostium and landing zone. Bottom panel: Real-time monitoring of device deployment and immediate sealing verification using color Doppler, confirming complete occlusion and enhancing procedural safety. (C) Surrounding anatomy protection. ICE enables 3D localization of the esophagus relative to the posterior left atrial (LA) wall, facilitating risk mitigation strategies to prevent atrioesophageal fistula formation. RA: right atrium; LA: left atrium.