Intra-cardiac Echocardiography (ICE) plays a critical role in Electrophysiology (EP) and Structural Heart Disease (SHD) interventions by providing real-time visualization of intracardiac structures. However, maintaining continuous visibility of the therapy device tip remains a challenge due to frequent adjustments required during manual ICE catheter manipulation. To address this, we propose an AI-driven tracking model that estimates the device tip incident angle and passing point within the ICE imaging plane, ensuring continuous visibility and facilitating robotic ICE catheter control. A key innovation of our approach is the hybrid dataset generation strategy, which combines clinical ICE sequences with synthetic data augmentation to enhance model robustness. We collected ICE images in a water chamber setup, equipping both the ICE catheter and device tip with electromagnetic (EM) sensors to establish precise ground-truth locations. Synthetic sequences were created by overlaying catheter tips onto real ICE images, preserving motion continuity while simulating diverse anatomical scenarios. The final dataset consists of 5,698 ICE-tip image pairs, ensuring comprehensive training coverage. Our model architecture integrates a pretrained ultrasound (US) foundation model, trained on 37.4M echocardiography images, for feature extraction. A transformer-based network processes sequential ICE frames, leveraging historical passing points and incident angles to improve prediction accuracy. Experimental results demonstrate that our method achieves 3.32 degree entry angle error, 12.76 degree rotation angle error. This AI-driven framework lays the foundation for real-time robotic ICE catheter adjustments, minimizing operator workload while ensuring consistent therapy device visibility. Future work will focus on expanding clinical datasets to further enhance model generalization.

Abstract: Extended Reality (XR) technologies are gaining traction as effective tools for medical training and procedural guidance, particularly in complex cardiac interventions. This paper presents a novel system for real-time 3D tracking and visualization of intracardiac echocardiography (ICE) catheters, with precise measurement of the roll angle. The system's data is integrated into an interactive Unity-based environment, rendered through the Meta Quest 3 XR headset, combining a dynamically tracked catheter with a patient-specific 3D heart model. This immersive environment allows the testing of the importance of 3D depth perception, in comparison to 2D projections, as a form of visualization in XR. Our experimental study, conducted using the ICE catheter with six participants, suggests that 3D visualization is not necessarily beneficial over 2D views offered by the XR system; although all cardiologists saw its utility for pre-operative training, planning, and intra-operative guidance. The proposed system qualitatively shows great promise in transforming catheter-based interventions, particularly ICE procedures, by improving visualization, interactivity, and skill development. Keywords: Percutaneous Cardiac Intervention, Extended Reality, Computer Vision, 3D visualization, ICE catheter, Roll Angle 1. INTRODUCTION Minimally invasive interventions (MII) have revolutionized the field of cardiac care, offering patients reduced recovery times, lower risks of complications, and shorter hospital stays compared to traditional open-heart surgeries. These procedures, such as percutaneous cardiac interventions, rely on the precise navigation of catheters through complex vascular structures and heart chambers[1-6].

Abstract-- Intra-cardiac Echocardiography (ICE) is a crucial imaging modality used in electrophysiology (EP) and structural heart disease (SHD) interventions, providing realtime, high-resolution views from within the heart. Despite its advantages, effective manipulation of the ICE catheter requires significant expertise, which can lead to inconsistent outcomes, particularly among less experienced operators. To address this challenge, we propose an AIdriven closed-loop view guidance system with human-inthe-loop feedback, designed to assist users in navigating ICE imaging without requiring specialized knowledge. Our method models the relative position and orientation vectors between arbitrary views and clinically defined ICE views in a spatial coordinate system, guiding users on how to manipulate the ICE catheter to transition from the current view to the desired view over time. Overview of the proposed view guidance system. The primary use cases of the ICE imaging involve visualizing target anatomy, detecting and tracking therapeutic devices, and validating treatments in real-time. HE Intra-cardiac Echocardiography (ICE) is a sophisticated imaging modality that offers real-time, highresolution have significant expertise in interpreting anatomical views views from within the heart, making it an invaluable via ICE images and skillfully maneuvering the ICE catheter tool in both electrophysiology (EP) and structural heart disease using two knobs (anterior-posterior, right-left) and the rotating/translating (SHD) interventions.

Intra-cardiac Echocardiography (ICE) has been evolving as a real-time imaging modality of choice for guiding electrophiosology and structural heart interventions. ICE provides real-time imaging of anatomy, catheters, and complications such as pericardial effusion or thrombus formation. However, there now exists a high cognitive demand on physicians with the increased reliance on intraprocedural imaging. In response, we present a robotic manipulator for AcuNav ICE catheters to alleviate the physician's burden and support applied methods for more automated. Herein, we introduce two methods towards these goals: (1) a data-driven method to compensate kinematic model errors due to non-linear elasticity in catheter bending, providing more precise robotic control and (2) an automated image recovery process that allows physicians to bookmark images during intervention and automatically return with the push of a button. To validate our error compensation method, we demonstrate a complex rotation of the ultrasound imaging plane evaluated on benchtop. Automated view recovery is validated by repeated imaging of landmarks on benchtop and in vivo experiments with position- and image-based analysis. Results support that a robotic-assist system for more autonomous ICE can provide a safe and efficient tool, potentially reducing the execution time and allowing more complex procedures to become common place.