Intra-cardiac echography (ICE) probes (Fig. 32.2.1) are widely used in electrophysiology for their good procedure guidance and relatively safe application. ASICs are increasingly employed in these miniature probes to enhance signal quality and reduce the number of connections needed in mm-diameter catheters -. 3D visualization in real-time is additionally enabled by 2D transducer arrays with, for each transducer element, a high-voltage (HV) transmit (TX) part, to generate acoustic pulses of sufficient pressure, and a receive (RX) path, to process the resulting echoes. To achieve the required reduction in RX channels, micro-beamforming (BF), which merges the signals from a subarray using a delay-and-sum operation, has been shown to be an effective solution , . However, due to the frame-rate reduction that is associated with BF, these designs cannot serve emerging high-frame-rate imaging modes (1000 volumes/s) like 3D blood-flow and elastography imaging. In-probe digitization has recently been investigated to provide further channel-count reduction, make data transmission more robust, and enable pre-processing in the probe -. However, these earlier designs have either no TX functionality ,  or only low-voltage (LV) TX  integrated. Combining BF and digitization with area-hungry HV transmitters in a pitch-matched scalable fashion while supporting high-frame-rate imaging remains an unmet challenge. The work presented in this paper meets this target, enabled by a hybrid ADC, the small die size of which allows for co-integration with 65V element-level pulsers.