Total Heart SimWhat you see
Continuing clockwise beyond the mitral valve and appendage brings the posterior-lateral left atrium into view, where the left superior and left inferior pulmonary veins enter. The ridge of tissue between the appendage and the left superior vein lies nearby.
Why it matters
Pulmonary vein isolation is the cornerstone of AF ablation. Seeing the vein ostia shows where the catheter, balloon or ablation lesions sit relative to the vein, and colour Doppler of the veins helps check flow.
How to get there
About 3 o'clock (90° clockwise)
Keep rotating clockwise past the mitral valve and appendage: the left superior and inferior veins appear entering the posterior-lateral left atrium.
In the simulator:
- Start from the home view (mid right atrium, neutral).
- Advance the catheter about 3.5 cm.
- Rotate clockwise about 90°, to about 3 o'clock.
- Deflect anteriorly (about 40° on the A/P dial).
- Tilt right (about 20° on the R/L dial).
Clinical uses
- Pulmonary vein isolation: catheter and balloon position at the vein ostia.
- Colour Doppler of pulmonary vein flow.
Frequently asked questions
How do you get the left pulmonary veins view on ICE?
Keep rotating clockwise past the mitral valve and appendage: the left superior and inferior veins appear entering the posterior-lateral left atrium. In the Total Heart Sim model heart: Advance the catheter about 3.5 cm. Rotate clockwise about 90°, to about 3 o'clock. Deflect anteriorly (about 40° on the A/P dial). Tilt right (about 20° on the R/L dial). Small adjustments either way are normal: anatomy and catheters vary.
References
- Enriquez A, Saenz LC, Rosso R, et al. Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it. Circulation. 2018;137:2278–2294.
- Haloot J, Schurmann P. Electrophysiology laboratory survival guide part 2: introduction to intracardiac echocardiography in the electrophysiology laboratory. US Cardiology Review. 2026;20:e16.
Educational content; not medical advice. Rotation and deflection values are typical teaching values in the simulator's model heart; real anatomy and catheters vary.
