Intracardiac echocardiography (ICE) with lower frequency is a new imaging modality. We present the case of a patient with dilated cardiomyopathy and recurrent supraventricular tachycardia due to a right posterolateral accessory pathway. ICE imaging was performed using a 9-MHz (9-Fr) catheter positioned in the right atrium and guided precise catheter localization at the lateral tricuspid annulus where the bypass tract was located, which facilitated successful radiofrequency ablation. In addition, ICE imaging detected anatomic abnormalities, including localized pericardial effusion and torn tricuspid chordae tendineae, which were all identified at the onset of the procedure. The effusions remained stable during imaging monitoring throughout the procedure, which helped reassure us that these abnormalities were not procedure related. In summary, ICE imaging may significantly improve procedural efficacy in selected catheter ablation procedure and help detect anatomic abnormalities, procedural complications, or both.