{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:17:14Z","timestamp":1783336634426,"version":"3.54.6"},"reference-count":92,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Atrial fibrillation (AF) and heart failure (HF) frequently coexist and mutually worsen prognosis, creating a complex clinical scenario in which treatment decisions are increasingly imaging driven. Catheter ablation has emerged as a pivotal rhythm control strategy in selected patients with HF, but careful phenotyping of the atrial and ventricular substrate is essential to balance potential benefits against procedural risk and the likelihood of durable sinus rhythm. In this narrative review, we summarize the role of multimodality imaging across the entire AF care pathway in patients with HF, from candidate selection to intraprocedural guidance and post-ablation follow-up. Ultrasound imaging remains the cornerstone of pre-procedural assessment. Cardiac computed tomography (CCT) refines anatomical characterization of the left atrium, pulmonary veins, and left atrial appendage. Cardiovascular magnetic resonance (CMR) offers comprehensive tissue characterization of atrial and ventricular fibrosis, allowing distinction between atrial primary and atrial secondary AF phenotypes and informing expectations of reverse remodelling. During ablation, intracardiac echocardiography and transesophageal echocardiography optimize transseptal access, catheter navigation, and complication monitoring, and they are particularly relevant with contemporary Pulsed Field Ablation systems. In follow-up, echocardiography, CCT, and CMR are pivotal for quantifying structural reverse remodelling and detecting rare but life-threatening complications such as atrio esophageal fistula and pulmonary vein stenosis. An integrated, multimodality, substrate-based imaging strategy is therefore crucial to personalize rhythm versus rate control decisions and to guide safe, effective ablation in patients with AF and HF.<\/jats:p>","DOI":"10.3390\/medicina62071296","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"1296","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Multimodality Imaging in Atrial Fibrillation and Heart Failure: From Patient Selection to Procedural Ablation Guidance"],"prefix":"10.3390","volume":"62","author":[{"given":"Elena","family":"Marchetti","sequence":"first","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Melpignano","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, 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, 44124 Ferrara, 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, 44124 Ferrara, 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, 44124 Ferrara, 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, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1558-4331","authenticated-orcid":false,"given":"Maria","family":"Lo Monaco","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Ospedale Humanitas Gavazzeni, Via Mauro Gavazzeni 21, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Mollace","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Ospedale Humanitas Gavazzeni, Via Mauro Gavazzeni 21, 24125 Bergamo, 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, 44124 Ferrara, 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, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-4881","authenticated-orcid":false,"given":"Federico","family":"Marchini","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2746","DOI":"10.1093\/eurheartj\/eht280","article-title":"Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060","volume":"34","author":"Krijthe","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.jacc.2024.07.014","article-title":"Minimum National Prevalence of Diagnosed Atrial Fibrillation Inferred from California Acute Care Facilities","volume":"84","author":"Noubiap","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1161\/CIRCULATIONAHA.115.018614","article-title":"Atrial Fibrillation Begets Heart Failure and Vice Versa","volume":"133","author":"Santhanakrishnan","year":"2016","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2774","DOI":"10.1016\/j.jacep.2025.09.014","article-title":"Atrial Fibrillation and Heart Failure with Reduced Ejection Fraction","volume":"11","author":"Boehmer","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(00)03230-X","article-title":"Rhythm or rate control in atrial fibrillation\u2014Pharmacological Intervention in Atrial Fibrillation (PIAF): A randomised trial","volume":"356","author":"Hohnloser","year":"2000","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.ahj.2004.11.030","article-title":"Rate control versus rhythm control for patients with persistent atrial fibrillation with mild to moderate heart failure: Results from the RAte Control versus Electrical cardioversion (RACE) study","volume":"149","author":"Hagens","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"(2002). Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Investigators. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. N. Engl. J. Med., 347, 1825\u20131833.","DOI":"10.1056\/NEJMoa021328"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter Ablation for Atrial Fibrillation with Heart Failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1001\/jamacardio.2024.0675","article-title":"Atrial Fibrillation Ablation in Heart Failure with Reduced vs Preserved Ejection Fraction: A Systematic Review and Meta-Analysis","volume":"9","author":"Oraii","year":"2024","journal-title":"JAMA Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/S0002-9149(02)02864-3","article-title":"Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden","volume":"90","author":"Tsang","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101364","DOI":"10.1016\/j.ijcha.2024.101364","article-title":"Left atrial volume index: A predictor of atrial fibrillation recurrence following direct current cardioversion\u2014A systematic review and meta-analysis","volume":"51","author":"Raniga","year":"2024","journal-title":"IJC Heart Vasc."},{"key":"ref_13","first-page":"33","article-title":"Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A meta-analysis","volume":"20","author":"Njoku","year":"2018","journal-title":"EP Eur."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.jacc.2019.01.059","article-title":"Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review","volume":"73","author":"Thomas","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Barilli, M., Mandoli, G.E., Sisti, N., Dokollari, A., Ghionzoli, N., Soliman-Aboumarie, H., D\u2019Ascenzi, F., Focardi, M., Cavigli, L., and Pastore, M.C. (2024). Potential Role of Left Atrial Strain to Predict Atrial Fibrillation Recurrence after Catheter Ablation Therapy: A Clinical and Systematic Review. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11070203"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/0002-9149(93)90884-F","article-title":"Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations","volume":"72","author":"Hwang","year":"1993","journal-title":"Am. J. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2875","DOI":"10.1016\/j.jacc.2021.04.036","article-title":"Prevalence of Left Atrial Thrombus in Anticoagulated Patients with Atrial Fibrillation","volume":"77","author":"Lurie","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0735-1097(94)90025-6","article-title":"Prognostic implications of left artial spontaneous echo contrast in nonvalvular atrial fibrillation","volume":"24","author":"Leung","year":"1994","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.echo.2014.08.016","article-title":"Prognostic Significance of Left Atrial Appendage \u201cSludge\u201d in Patients with Atrial Fibrillation: A New Transesophageal Echocardiographic Thromboembolic Risk Factor","volume":"27","author":"Lowe","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70233","DOI":"10.1002\/joa3.70233","article-title":"Reduced Left Atrial Appendage Flow Velocity as a Risk of Thromboembolic Events After Catheter Ablation of Atrial Fibrillation","volume":"41","author":"Yamagami","year":"2025","journal-title":"J. Arrhythm."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/ehjci\/jex312","article-title":"Applications of cardiac computed tomography in electrophysiology intervention","volume":"19","author":"Liddy","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1111\/j.1540-8167.2006.00594.x","article-title":"The Impact of CT Image Integration into an Electroanatomic Mapping System on Clinical Outcomes of Catheter Ablation of Atrial Fibrillation","volume":"17","author":"Kistler","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jacep.2025.09.042","article-title":"Left Atrial Wall Thickness as a Marker of Atrial Substrate in Patients with Atrial Fibrillation","volume":"12","author":"Lim","year":"2026","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.hrthm.2010.03.027","article-title":"Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography: Implications for balloon-based procedures","volume":"7","author":"Horton","year":"2010","journal-title":"Heart Rhythm."},{"key":"ref_25","first-page":"e014386","article-title":"Preprocedural Multimodality Imaging in Atrial Fibrillation","volume":"15","author":"Quintana","year":"2022","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1161\/CIRCIMAGING.112.000153","article-title":"Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: A meta-analysis","volume":"6","author":"Romero","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s00059-017-4676-9","article-title":"Cardiac MRI for detecting left atrial\/left atrial appendage thrombus in patients with atrial fibrillation","volume":"44","author":"Chen","year":"2019","journal-title":"Herz"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.ijcard.2015.11.073","article-title":"Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation","volume":"203","author":"Kato","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.jcmg.2015.03.008","article-title":"Incidental LV LGE on CMR Imaging in Atrial Fibrillation Predicts Recurrence After Ablation Therapy","volume":"8","author":"Suksaranjit","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcmg.2013.08.013","article-title":"Myocardial Extracellular Volume Expansion and the Risk of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation","volume":"7","author":"Neilan","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1001\/jama.2014.3","article-title":"Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation","volume":"311","author":"Marrouche","year":"2014","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1111\/jce.14957","article-title":"Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design","volume":"32","author":"Marrouche","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4384","DOI":"10.1007\/s00330-022-08598-6","article-title":"The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings: An up-to-date review","volume":"32","author":"Cau","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Anagnostopoulos, I., Kousta, M., Kossyvakis, C., Paraskevaidis, N.T., Vrachatis, D., Deftereos, S., and Giannopoulos, G. (2023). Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196369"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ballatore, A., Gatti, M., Mella, S., Tore, D., Xhakupi, H., Giorgino, F., Saglietto, A., Carmagnola, L., Roagna, E., and De Ferrari, G.M. (2024). Epicardial Atrial Fat at Cardiac Magnetic Resonance Imaging and AF Recurrence after Transcatheter Ablation. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11050137"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100657","DOI":"10.1016\/j.jacadv.2023.100657","article-title":"Uncovering the Role of Epicardial Adipose Tissue in Heart Failure with Preserved Ejection Fraction","volume":"2","author":"Goldman","year":"2023","journal-title":"JACC Adv."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.pcad.2014.05.009","article-title":"Interventional Echocardiography","volume":"57","author":"Pislaru","year":"2014","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.jcin.2016.10.035","article-title":"Transseptal Techniques for Emerging Structural Heart Interventions","volume":"9","author":"Alkhouli","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/europace\/eur366","article-title":"Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators","volume":"14","author":"Bayrak","year":"2012","journal-title":"Europace"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1016\/j.jacc.2009.01.071","article-title":"The Use of Intracardiac Echocardiography and Other Intracardiac Imaging Tools to Guide Noncoronary Cardiac Interventions","volume":"53","author":"Kim","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"010801","DOI":"10.1115\/1.4035374","article-title":"Novel Solutions Applied in Transseptal Puncture: A Systematic Review","volume":"11","author":"Morais","year":"2017","journal-title":"J. Med. Devices"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/joic.12170","article-title":"Use of EchoNavigator, a Novel Echocardiography-Fluoroscopy Overlay System, for Transseptal Puncture and Left Atrial Appendage Occlusion","volume":"28","author":"Gafoor","year":"2015","journal-title":"J. Interv. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.echo.2004.03.034","article-title":"Transesophageal echocardiography to guide pulmonary vein mapping and ablation for atrial fibrillation","volume":"17","author":"Kinnaird","year":"2004","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1093\/europace\/euq297","article-title":"Transseptal puncture using minimally invasive echocardiography during atrial fibrillation ablation","volume":"12","author":"Lellouche","year":"2010","journal-title":"Europace"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S237","DOI":"10.1016\/j.jacr.2024.02.024","article-title":"ACR Appropriateness Criteria\u00ae Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation","volume":"21","author":"Agarwal","year":"2024","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.echo.2008.12.013","article-title":"Echocardiography-Guided Interventions","volume":"22","author":"Silvestry","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e70096","DOI":"10.1111\/echo.70096","article-title":"Clinical Outcomes of Intracardiac Echocardiography-Guided Radiofrequency Catheter Ablation for Atrial Fibrillation: A Retrospective Study","volume":"42","author":"Long","year":"2025","journal-title":"Echocardiography"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"euag002","DOI":"10.1093\/europace\/euag002","article-title":"Safety and efficacy of intracardiac echocardiography in atrial fibrillation ablation: A meta-analysis","volume":"28","author":"Karakasis","year":"2026","journal-title":"Europace"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Bottoni, N., Donateo, P., Rossi, L., Malag\u00f9, M., Tomasi, L., Quartieri, F., Biagi, A., Iori, M., Mugnai, G., and Battista, A. (2023). Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10020062"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/jce.15423","article-title":"Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta-analysis of observational and randomized studies","volume":"33","author":"Xu","year":"2022","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1111\/j.1540-8167.2010.01796.x","article-title":"Intracardiac Echocardiography Improves Procedural Efficiency During Cryoballoon Ablation for Atrial Fibrillation: A Pilot Study","volume":"21","author":"Schmidt","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1111\/jce.16060","article-title":"Impact of intracardiac echocardiography usage on the safety of cryoballoon atrial fibrillation ablation: Subanalysis of the prospective FREEZE cluster cohort study","volume":"34","author":"Pongratz","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_53","first-page":"e1","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"20","author":"Calkins","year":"2018","journal-title":"EP Eur."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1001\/jamacardio.2025.3687","article-title":"Intracardiac vs Transesophageal Echocardiography in Atrial Fibrillation Ablation","volume":"10","author":"Hu","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Leuzzi, F., Formisano, C., Cerrato, E., Maione, A., Attisano, T., Meucci, F., Ciccarelli, M., Vecchione, C., Galasso, G., and Di Muro, F.M. (2026). Intracardiac Echocardiography in Structural Heart Interventions: A Comprehensive Overview. J. Clin. Med., 15.","DOI":"10.3390\/jcm15030926"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/HCO.0000000000001094","article-title":"Perspectives on pulsed field ablation: How to judge endpoints","volume":"39","author":"Anglesio","year":"2024","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_57","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":"ref_58","doi-asserted-by":"crossref","unstructured":"Pierucci, N., Mariani, M.V., Laviola, D., Silvetti, G., Cipollone, P., Vernile, A., Trivigno, S., La Fazia, V.M., Piro, A., and Miraldi, F. (2024). Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102980"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa2307291","article-title":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation","volume":"389","author":"Reddy","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1161\/CIRCULATIONAHA.124.070333","article-title":"Pulsed Field Ablation to Treat Paroxysmal Atrial Fibrillation: Safety and Effectiveness in the AdmIRE Pivotal Trial","volume":"150","author":"Reddy","year":"2024","journal-title":"Circulation"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/pace.70082","article-title":"Evaluating Pulsed Field Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Procedural Outcomes","volume":"49","author":"Prajapati","year":"2026","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/postmj\/qgaf049","article-title":"Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: A systematic review and meta-analysis","volume":"101","author":"Kaddoura","year":"2025","journal-title":"Postgrad. Med. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e013977","DOI":"10.1161\/CIRCEP.125.013977","article-title":"2025 International Expert Practical Guide on the Use of the Pentaspline Pulsed Field Ablation System in Atrial Fibrillation Ablation Procedures","volume":"18","author":"Chen","year":"2025","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3172","DOI":"10.1136\/openhrt-2025-003172","article-title":"Open access Initial experience of transoesophageal echocardiography-guided percutaneous pulsed field ablation of atrial fibrillation Arrhythmias and sudden death","volume":"12","author":"Liu","year":"2025","journal-title":"Open Heart"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"euad183","DOI":"10.1093\/europace\/euad183","article-title":"Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias","volume":"25","author":"Berruezo","year":"2023","journal-title":"Europace"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e230222","DOI":"10.1148\/rg.230222","article-title":"Utility of CT and MRI in Cardiac Electrophysiology","volume":"44","author":"Bugenhagen","year":"2024","journal-title":"RadioGraphics"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jcmg.2016.03.009","article-title":"Multimodality Imaging for Guiding EP Ablation Procedures","volume":"9","author":"Njeim","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/jce.16152","article-title":"Cardiac magnetic resonance for early atrial lesion visualization post atrial fibrillation radiofrequency catheter ablation","volume":"35","author":"Guglielmo","year":"2024","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1016\/j.jacep.2023.08.013","article-title":"Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance","volume":"9","author":"Hopman","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_70","first-page":"520","article-title":"Catheter ablation of atrial fibrillation: Cardiac imaging guidance as an adjunct to the electrophysiological guided approach","volume":"23","author":"Markman","year":"2021","journal-title":"EP Eur."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1111\/pace.14864","article-title":"Pulsed field ablation for atrial fibrillation\u2014Lessons from magnetic resonance imaging","volume":"46","author":"Fink","year":"2023","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/j.1540-8159.2008.00986.x","article-title":"Integration of three-dimensional left atrial magnetic resonance images into a real-time electroanatomic mapping system: Validation of a registration method","volume":"31","author":"Bertaglia","year":"2008","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1111\/j.1540-8159.2007.00843.x","article-title":"Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation","volume":"30","author":"Martinek","year":"2007","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Bertini, M., Pompei, G., Tolomeo, P., Malag\u00f9, M., Fiorio, A., Balla, C., Vitali, F., and Rapezzi, C. (2021). Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures-A Novel Workflow for Atrial Fibrillation. Biology, 10.","DOI":"10.3390\/biology10121333"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1540-8167.2010.01927.x","article-title":"Different patterns of atrial remodeling after catheter ablation of chronic atrial fibrillation","volume":"22","author":"Lo","year":"2011","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1002\/ehf2.14365","article-title":"Echocardiographic Pattern of Left Ventricular Function Recovery in Tachycardia-Induced Cardiomyopathy Patients","volume":"10","author":"Serban","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Chen, Y.L., Hou, B.Y., Chen, H.H., Lin, P.T., and Wang, H.T. (2026). Left Atrial Size Modification After Catheter Ablation Predicts Late Atrial Fibrillation Recurrence. Diagnostics, 16.","DOI":"10.3390\/diagnostics16040628"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"9511","DOI":"10.1038\/s41598-022-13725-w","article-title":"Effect of radiofrequency catheter ablation on left atrial structure and function in patients with different types of atrial fibrillation","volume":"12","author":"Liu","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1016\/j.jacep.2023.07.025","article-title":"Early Remodeling of the Left Atrium Following Catheter Ablation of Atrial Fibrillation","volume":"9","author":"Assaf","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1161\/CIRCEP.117.005579","article-title":"Atrioesophageal Fistula: Clinical Presentation, Procedural Characteristics, Diagnostic Investigations, and Treatment Outcomes","volume":"10","author":"Han","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"euae108","DOI":"10.1093\/europace\/euae108","article-title":"Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: A clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology","volume":"26","author":"Deneke","year":"2024","journal-title":"Europace"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1378\/chest.128.4.2581","article-title":"Anatomic Relationship of the Esophagus and Left Atrium","volume":"128","author":"Tsao","year":"2005","journal-title":"Chest"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/CIRCEP.109.859116","article-title":"Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation","volume":"3","author":"Cappato","year":"2010","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4330\/wjc.v8.i1.81","article-title":"Pulmonary vein stenosis: Etiology, diagnosis and management","volume":"8","year":"2016","journal-title":"World J. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1046\/j.1540-8167.2005.40724.x","article-title":"Changes of Pulmonary Vein Orifice Size and Location throughout the Cardiac Cycle: Dynamic Analysis Using Magnetic Resonance Cine Imaging","volume":"16","author":"Lickfett","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_86","first-page":"35","article-title":"Drug-coated balloon angioplasty for severe pulmonary vein stenosis resulting from cryoballoon ablation for atrial fibrillation","volume":"26","author":"Yamaguchi","year":"2022","journal-title":"J. Cardiol. Cases"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e006001","DOI":"10.1161\/CIRCEP.117.006001","article-title":"Outcomes and Management of Patients with Severe Pulmonary Vein Stenosis from Prior Atrial Fibrillation Ablation","volume":"11","author":"Wazni","year":"2018","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_88","first-page":"e014804","article-title":"Intra- and Postprocedural Multimodality Imaging in Atrial Fibrillation","volume":"15","author":"Quintana","year":"2022","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.jacc.2008.05.062","article-title":"New Magnetic Resonance Imaging-Based Method for Defining the Extent of Left Atrial Wall Injury After the Ablation of Atrial Fibrillation","volume":"52","author":"McGann","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/1532-429X-15-105","article-title":"Evaluation of current algorithms for segmentation of scar tissue from late Gadolinium enhancement cardiovascular magnetic resonance of the left atrium: An open-access grand challenge","volume":"15","author":"Karim","year":"2013","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jcmg.2008.10.016","article-title":"Recurrence of Atrial Fibrillation Correlates with the Extent of Post-Procedural Late Gadolinium Enhancement","volume":"2","author":"Peters","year":"2009","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1540-8167.2009.01611.x","article-title":"Magnetic Resonance Imaging-Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience","volume":"21","author":"Segerson","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1296\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:30:16Z","timestamp":1783333816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,5]]},"references-count":92,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medicina62071296"],"URL":"https:\/\/doi.org\/10.3390\/medicina62071296","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,5]]}}}