{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:10:41Z","timestamp":1789143041444,"version":"build-2803163510"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":62,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Transoesophageal echocardiography (TOE) provides real-time soft-tissue anatomical information during pulsed field ablation (PFA) of atrial fibrillation. This focused technical report describes a standardized workflow in which TOE complements, rather than replaces, fluoroscopic, and angiographic guidance throughout the procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technique<\/jats:title>\n                    <jats:p>The workflow is organized into four consecutive phases: pre-procedural assessment, transseptal puncture, ablation\u2013catheter configuration and positioning at the pulmonary vein ostia, and post-procedural assessment. Pre-procedural TOE focuses on exclusion of left atrial appendage thrombus, definition of pulmonary vein anatomy, assessment of the interatrial septum, and baseline evaluation for pericardial effusion. During transseptal access, orthogonal bicaval and short-axis views support puncture-site selection and continuous visualization of septal tenting, while fluoroscopy remains integral to guidewire and transseptal-system manipulation. During ablation, TOE complements fluoroscopic\/angiographic guidance by depicting catheter configuration and its relationship with the pulmonary vein ostia and adjacent soft-tissue structures. At procedure completion, TOE is used to assess the iatrogenic interatrial septal defect and to exclude new pericardial effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TOE should be considered a complementary imaging modality during fluoroscopy- and angiography-guided PFA rather than a replacement for these techniques. Its principal contribution is real-time visualization of soft-tissue anatomy, transseptal puncture, catheter\u2013tissue relationships, and immediate post-procedural complications. Prospective studies are required to quantify its incremental clinical value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag155","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:22:31Z","timestamp":1788348151000},"source":"Crossref","is-referenced-by-count":0,"title":["Transoesophageal echocardiography as complementary imaging during pulsed field ablation of atrial fibrillation: a practical step-by-step approach"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-4881","authenticated-orcid":false,"given":"Federico","family":"Marchini","sequence":"first","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0596-2521","authenticated-orcid":false,"given":"Matteo","family":"Arzenton","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3166-0542","authenticated-orcid":false,"given":"Federica","family":"Frascaro","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5006-156X","authenticated-orcid":false,"given":"Luca","family":"Canovi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1972-9665","authenticated-orcid":false,"given":"Michele","family":"Malag\u00f9","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0667-7616","authenticated-orcid":false,"given":"Francesco","family":"Vitali","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6947-4931","authenticated-orcid":false,"given":"Sofia","family":"Meossi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1438-775X","authenticated-orcid":false,"given":"Laura","family":"Rotondo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-188X","authenticated-orcid":false,"given":"Gianluca","family":"Campo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5285-7140","authenticated-orcid":false,"given":"Matteo","family":"Bertini","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-9711","authenticated-orcid":false,"given":"Rita","family":"Pavasini","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara , Via Aldo Moro 8, Ferrara 44124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"2026091111370401100_qyag155-B1","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1056\/NEJMoa2502280","article-title":"Pulsed field or cryoballoon ablation for paroxysmal atrial fibrillation","volume":"392","author":"Reichlin","year":"2025","journal-title":"N Engl J Med"},{"key":"2026091111370401100_qyag155-B2","doi-asserted-by":"crossref","first-page":"euae134","DOI":"10.1093\/europace\/euae134","article-title":"State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective","volume":"26","author":"Chun","year":"2024","journal-title":"Europace"},{"key":"2026091111370401100_qyag155-B3","doi-asserted-by":"crossref","first-page":"e003172","DOI":"10.1136\/openhrt-2025-003172","article-title":"Initial experience of transoesophageal echocardiography-guided percutaneous pulsed field ablation of atrial fibrillation","volume":"12","author":"Liu","year":"2025","journal-title":"Open Heart"},{"key":"2026091111370401100_qyag155-B4","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1001\/jamacardio.2025.3687","article-title":"Intracardiac vs transesophageal echocardiography in atrial fibrillation ablation: a randomized clinical trial","volume":"10","author":"Hu","year":"2025","journal-title":"JAMA Cardiol"},{"key":"2026091111370401100_qyag155-B5","doi-asserted-by":"crossref","first-page":"euag080","DOI":"10.1093\/europace\/euag080","article-title":"Pulsed field ablation for the interventional treatment of atrial fibrillation: a scientific statement of the European Heart Rhythm Association of the European Society of Cardiology, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society","volume":"28","author":"K\u00fchne","year":"2026","journal-title":"Europace"},{"key":"2026091111370401100_qyag155-B6","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026091111370401100_qyag155-B7","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.echo.2013.07.009","article-title":"Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologists","volume":"26","author":"Hahn","year":"2013","journal-title":"J Am Soc Echocardiogr"},{"key":"2026091111370401100_qyag155-B8","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.hrthm.2024.02.002","article-title":"ST-segment elevation in pulsed field ablation for atrial fibrillation","volume":"21","author":"Farina","year":"2024","journal-title":"Heart Rhythm"},{"key":"2026091111370401100_qyag155-B9","doi-asserted-by":"crossref","first-page":"3164","DOI":"10.1016\/j.jacc.2020.04.069","article-title":"Safety of transesophageal echocardiography to guide structural cardiac interventions","volume":"75","author":"Freitas-Ferraz","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026091111370401100_qyag155-B10","doi-asserted-by":"crossref","first-page":"qyag048","DOI":"10.1093\/ehjimp\/qyag048","article-title":"Artificial intelligence based fusion imaging streamlining mitral transcatheter edge-to-edge repair","volume":"4","author":"Biaggi","year":"2026","journal-title":"Eur Heart J Imaging Methods Pract"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/advance-article-pdf\/doi\/10.1093\/ehjimp\/qyag155\/70922069\/qyag155.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag155\/70922069\/qyag155.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag155\/70922069\/qyag155.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:37:10Z","timestamp":1789141030000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyag155\/8779941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyag155","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,2]]},"article-number":"qyag155"}}