The growth of interventional electrophysiology in recent years has placed a greater demand on imaging guidance. Currently available imaging modalities to guide interventions, while useful, have significant limitations. Intracardiac echocardiography has the potential to improve on these limitations and evolve into a modality that could provide imaging guidance, aid in the prevention or instant identification of complications, help identify and quantify ablative lesions, and contribute toward visualization of normal and abnormal conduction pathways. Ongoing developments in catheter design in the form of lower frequency, smaller size, and preshaped catheters should enhance the role of intracardiac echocardiography in interventional electrophysiology. There is the potential to combine the imaging and ablative capabilities of intracardiac ultrasonography to make for an imaging and therapeutic tool.