Search Results (281)

Gaseous microemboli (GME) represent a common complication of cardiac structural interventions across both surgical and transcatheter approaches. Intraoperative transesophageal echocardiography (TEE) represents a convenient methodology to monitor and visualize the presence of circulating GME. However, their detection and quantification are far from trivial due to operator-dependent view, high velocity, and objects with similar structure in the background. Here, we propose a feasibility study based on a 2.5D U-Net architecture to detect GME in space-time connected data. We applied and tested such an architecture on a pilot dataset of eight TEE recordings (60 fps, $600\times 800$ pixels) from eight different patients undergoing cardiac surgery, resulting in improved detection of moving GMEs against the background with respect to classical spot detection algorithms and 2D U-Net, yet retaining real-time execution speed with respect to more complex deep-learning architectures. Under leave-one-patient-out cross-validation, the selected model achieved strong detection performance under a three-pixel radius-tolerant grace-zone evaluation, with a precision of 92.55% and recall of 80.54%, corresponding to radius-tolerant Intersection over Union (IoU) and Dice coefficients of 73.95% and 84.13%, respectively. Complementarily, strict pixel-based segmentation metrics were also computed, yielding an IoU of 41.74% and a Dice coefficient of 57.98%. The selected model achieved an average inference time of $0.12 \mathrm{s}$ per batch on the tested hardware. To assess specificity on unseen data, we additionally evaluated the model on an external GME-negative TEE dataset, where it produced predominantly empty or near-empty masks, indicating a low rate of spurious detections. These results support the technical feasibility of real-time GME segmentation, although broader clinical validation on larger multi-patient, multicenter datasets is still required. Full article

Transseptal puncture constitutes the foundational step required for left atrial access, serving as the critical gateway for pulmonary vein isolation, left-sided electrophysiological ablations, and percutaneous structural heart interventions. Although fluoroscopically guided transseptal puncture demonstrates high technical success rates alongside low reported complication rates, procedural training historically relies on unstructured apprenticeship models where overlooked mechanical nuances generate the majority of periprocedural adverse events. Methodological execution demands precise interatrial septal mapping, preprocedural left atrial thrombus screening, systemic anticoagulation, and rigorous hardware de-airing protocols. Real-time imaging using transesophageal or intracardiac echocardiography enhances fluoroscopic landmarks, facilitating precise localized puncture at the thin fossa ovalis while safeguarding adjacent anatomical structures such as the aortic root, posterior left atrial wall, and pericardial space. Modern auxiliary technologies, including radiofrequency crossing devices, provide systematic escalation strategies for fibrotic or altered septal substrates. Left atrial access must be unequivocally confirmed before dilator or sheath advancement using appropriate imaging, hemodynamic, or other procedural confirmation methods according to the technique employed. Ultimate procedural safety and operator competence depend on maintaining rigorous multi-modality confirmation protocols rather than relying on technical improvisation. Full article

Background: The 2023 European Society of Cardiology (ESC) guideline and the 2023 WikiGuideline both support intravenous (IV)–oral antibiotic switch in selected patients with infective endocarditis but apply different eligibility criteria. We aimed to assess hypothetical eligibility according to both guideline sets and to describe actual IV–oral switch practice at our center. Methods: In this retrospective observational study, adult patients with possible or definite streptococcal or enterococcal infective endocarditis treated between January 2024 and January 2026 were included. Eligibility for IV–oral switch was retrospectively assessed according to the original ESC criteria and WikiGuideline criteria using a predefined hypothetical switch date. Actual IV–oral switches performed in clinical practice and their clinical outcomes were described separately. Results: Ninety patients were included. Based on the original ESC criteria, two patients (2.2%) were hypothetically eligible for IV–oral switch, compared with 67 patients (74.4%) according to the WikiGuideline criteria. The principal reason for ESC ineligibility was the absence of repeat transesophageal echocardiography before the hypothetical switch date. In clinical practice, 22 patients (24.4%) underwent IV–oral switch. None of these patients fulfilled original ESC eligibility criteria, whereas all fulfilled the WikiGuideline criteria. Clinical outcomes of patients who underwent IV–oral switch are presented descriptively. Conclusions: In this retrospective cohort, hypothetical eligibility for IV–oral switch differed substantially depending on whether the ESC or WikiGuideline criteria were applied. At our center, local imaging practice accounted for most ESC ineligibility. Prospective studies are needed to determine which eligibility criteria and imaging approaches best identify patients who can safely undergo IV–oral switch. Full article

Background: Enterococcus faecalis is the third leading cause of infective endocarditis (IE) and remains the predominant enterococcal species involved in this condition, particularly among older patients with multiple comorbidities and healthcare-associated exposure. Its diagnosis may be challenging because the disease often follows a subacute course and may initially present with atypical extracardiac manifestations. Case presentation: We report the case of a 76-year-old man admitted with a 5-day history of fever, chills, profuse diaphoresis, myalgia, abdominal pain, and progressive confusion. On admission, he was febrile, hypotensive, disoriented, and presented with neck stiffness, a grade IV aortic murmur, suprapubic tenderness, hepatomegaly, and hemorrhagic lesions of the left hand. Initial transthoracic echocardiography did not reveal valvular vegetations. Cerebrospinal fluid analysis showed inflammatory changes with marked granulocytic predominance, whereas the multiplex PCR panel for meningitis/encephalitis pathogens and conventional cerebrospinal fluid cultures remained negative. In contrast, all blood cultures yielded E. faecalis. Repeat cranial computed tomography demonstrated a focal parasagittal frontal lesion involving the rostrum and genu of the corpus callosum, consistent with septic embolic involvement. Transesophageal echocardiography performed on hospital day 5 confirmed aortic valve IE, showing vegetative lesions on all cusps, the largest measuring approximately 8 mm, and severe aortic regurgitation. The clinical course was further complicated by cardiac decompensation and acute inflammatory involvement of the left knee, with synovial fluid analysis demonstrating a neutrophil-predominant inflammatory effusion, although cultures remained sterile. The patient received ampicillin plus vancomycin, followed by ampicillin plus linezolid after vancomycin-associated renal impairment. Follow-up blood cultures became negative after 3 weeks of treatment, but persistent severe aortic valve involvement required referral for cardiac surgical evaluation. The patient was readmitted to the cardiology department and subsequently developed multi-organ system failure, resulting in death one week after discharge. Conclusions: This case highlights the diagnostic complexity of. E. faecalis IE when meningocerebral and osteoarticular manifestations dominate the initial presentation, emphasizing the importance of repeated blood cultures and early transesophageal echocardiography. Full article

Systolic anterior motion (SAM) of the mitral valve can occur either in association with or in the absence of hypertrophic obstructive cardiomyopathy (HOCM). SAM induces dynamic left ventricular outflow tract obstruction (LVOTO) and, in the majority of cases, is associated with a substantial degree of mitral regurgitation (MR) that significantly impacts patient morbidity and mortality. This narrative review explores the contemporary understanding of the pathophysiology, diagnosis, and management of SAM, focusing particularly on surgical strategies and the novel therapeutic class of cardiac myosin inhibitors. Extended septal myectomy remains the gold-standard treatment for HOCM-related SAM, yielding superior long-term outcomes compared to alcohol septal ablation (ASA). Advanced imaging modalities, including three-dimensional transesophageal echocardiography (3D-TEE), enable precise pre-operative characterization of the mitral valve apparatus. Some patients may benefit from septal reduction strategies while concomitant mitral valve interventions are generally reserved for highly selected cases with intrinsic valve pathology or persistent residual SAM, thereby avoiding unnecessary valvular manipulation and its potential hemodynamic risks. Mavacamten, a selective cardiac myosin inhibitor, represents an important advance in pharmacological management, achieving a mean LVOT gradient reduction of 37.2 mmHg in symptomatic patients. Furthermore, data from the MARVEL registry confirm the real-world clinical efficacy of mavacamten in obstructive hypertrophic cardiomyopathy, with 86% of patients successfully down-staged to NYHA functional class I–II. Although ASA serves as a viable alternative to surgery, it entails a higher risk of conduction abnormalities requiring permanent pacemaker implantation and subsequent re-intervention. Beyond classical hypertrophic SAM, this review addresses the diagnosis and management of post-mitral repair complications and non-hypertrophic variants. Optimal management and risk stratification remain an evolving field requiring a multidisciplinary Heart Team approach, leverage of advanced imaging, and adoption of novel medical therapies. Interventional strategies must be carefully tailored to maximize the efficacy-to-safety profile on an individualized patient basis. Full article

Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols. Full article

Myocardial strain imaging, derived from speckle-tracking echocardiography (STE), has evolved from a research tool into a reproducible technique for detecting subclinical myocardial dysfunction. Recent advances in automated contouring and artificial intelligence have improved feasibility, reproducibility, and analysis speed, making multichamber strain assessment increasingly accessible in perioperative practice. Perioperative cardiovascular complications, including myocardial injury after non-cardiac surgery (MINS), postoperative atrial fibrillation (POAF), and heart failure, are associated with substantial postoperative morbidity and mortality. Conventional echocardiographic parameters, particularly left ventricular ejection fraction (LVEF), lack sensitivity for detecting early myocardial dysfunction. By quantifying myocardial deformation, strain imaging identifies subtle abnormalities in ventricular and atrial mechanics before conventional echocardiographic abnormalities become evident. Among available parameters, left ventricular global longitudinal strain (LV-GLS) and left atrial reservoir strain (LASr) provide the strongest evidence for perioperative risk stratification, with impaired values independently associated with MINS and POAF, respectively. Right ventricular strain (RV-GLS, RV-FWLS) and right atrial reservoir strain (RASr) remain promising but less standardized parameters supported mainly by observational data. Despite these advances, several barriers continue to limit widespread implementation, including vendor variability, the lack of standardized thresholds, and the absence of validated transesophageal echocardiography (TEE)-specific reference values. Importantly, current evidence supports myocardial strain primarily as a tool for risk stratification rather than for guiding therapy. No randomized trial has demonstrated that strain-guided perioperative management improves clinical outcomes, and its incremental value beyond established perioperative tools, including clinical risk scores, biomarkers, and conventional echocardiography, remains to be established. This review aims to provide a practical framework for the perioperative use of myocardial strain by summarizing the current evidence, clarifying its methodological limitations, simplifying its acquisition and interpretation for non-expert users, distinguishing established clinical applications from future research directions, and identifying the key evidence gaps that must be addressed before strain-guided strategies can be incorporated into routine perioperative care. Full article

Background/Objectives: Vegetation length is a guideline-endorsed criterion for surgery in left-sided infective endocarditis (LSIE). However, its measurement is highly variable with crucial implications for decision making. A standardized measurement system would not only facilitate decision making in these patients, but also cutoff-point optimization for improving clinical guidelines. For this purpose, this work introduces an Artificial Intelligence (AI)-based system capable of extracting vegetation length from standard transesophageal echocardiography (TEE). Methods: Five echocardiographers independently measured the vegetation length of 76 vegetations from 67 consecutive patients with LSIE using offline TEE images. The AI-based system was trained on a multicenter registry with 353 patients with LSIE, comprising 282,096 echocardiographic frames annotated by an independent expert. This system was applied to measure vegetation length as an independent observer. The variability and correlation between operators and the system were assessed. Results: Lin’s concordance correlation coefficient between the AI-based system and the mean of the measurements obtained by the echocardiographers was 0.74, comparable to the coefficient obtained between the echocardiographers themselves. Bland–Altman analysis showed a mean difference of −1.0 mm between the AI-based system and the mean of the measurements obtained by the echocardiographers. Conclusions: The AI-based system for vegetation measurement demonstrates a high level of correlation and agreement with experts, similar to the concordance between human operators themselves. This level of agreement suggests that the method has the potential to reduce inter-operator variability in the measurement process. Whether AI-based vegetation size improves embolism prediction has to be further investigated. Full article

Background/Objectives: Cardiac implantable electronic device (CIED) infections are infrequent but clinically significant, and Latin American—particularly Chilean—data remain scarce. We aimed to describe the clinical and microbiological profile, complications, mortality, and local infection burden of CIED infections at a tertiary center in southern Chile. Methods: This was a retrospective descriptive cohort study of all patients treated for CIED infection at Hospital Dr. Hernán Henríquez Aravena between January 2015 and December 2021. Crude per-procedure infection proportions were calculated using locally implanted devices (primary implants, generator replacements, and upgrades) as the denominator; because annual implant volumes and individual follow-up times were not retrievable, only exploratory approximate rates per 100 patient-years were derived under strong assumptions and were not used for formal comparison. Results: Fifty-four patients were included (77.8% men; mean age 69 ± 14 years). Predominant comorbidities were arterial hypertension (79.6%), heart failure (40.7%), atrial fibrillation (27.8%), and type 2 diabetes mellitus (24.1%). Pacemakers accounted for 59.3% of infections, and late-onset cases predominated (48.2%). The overall per-procedure infection proportion was 1.4% (95% confidence interval [CI] 1.1–1.9%) and was numerically higher for implantable cardioverter-defibrillators (ICDs; 5.5%) and cardiac resynchronization therapy (CRT) devices (4.3%) than for pacemakers (1.1%). Coagulase-negative Staphylococcus (43.2%) and Staphylococcus aureus (24.3%) were the leading isolates, although microbiological sampling was incomplete (available in 68.5%). Complete system extraction was attempted in all patients and achieved in all but one case; recurrence occurred in 9.3% and in-hospital mortality in 1.9%. Conclusions: The clinical and microbiological profile of CIED infections in this single-center southern Chilean cohort was broadly consistent with international series. Per-procedure proportions for ICDs and CRT devices were numerically higher than those for pacemakers, but the retrospective design, a procedure-based denominator including replacements and upgrades, and incomplete echocardiographic and microbiological workup preclude formal comparison with time-to-event registries; these device-specific findings should be regarded as exploratory and hypothesis-generating. The findings identify concrete, locally actionable targets: more systematic microbiological sampling, broader pre-procedural and diagnostic echocardiography (including transesophageal studies), and strengthened long-term follow-up of CIED carriers. Full article

Background and Objectives: Left atrial appendage (LAA) closure is a Class I recommendation in patients with atrial fibrillation to reduce the risk of cardioembolic stroke. Achieving reliable and complete LAA exclusion during minimally invasive mitral valve surgery via right minithoracotomy remains technically challenging. We report here to our knowledge the largest series of a novel technique for LAA exclusion using an epicardial clip device applied via right minithoracotomy during minimally invasive mitral valve surgery. Materials and Methods: Between June 2023 and May 2026, 40 patients with atrial fibrillation underwent minimally invasive mitral valve surgery via right minithoracotomy with concomitant LAA exclusion. Cardiopulmonary bypass was established via percutaneous femoral cannulation. Following completion of the intracardiac procedure and prior to aortic cross-clamp removal, a suture was placed around the LAA base via the transverse sinus and used to guide clip deployment under direct vision. Successful closure was confirmed by intraoperative transesophageal echocardiography. Results: Mean patient age was 66.6 ± 8.0 years; 21 patients (53%) were female. Mitral valve repair was performed in 36 patients (90%) and replacement in 4 (10%). Concomitant cryoablation for AF was performed in 31 patients (78%). Successful LAA clip deployment was achieved in all 40 patients (100%). The 35 mm clip was used in 36 patients (90%), the 40 mm clip in 3 patients (8%), and the 45 mm clip in 1 patient (2%). Mean total operative time was 183 ± 58 min; mean CPB time was 134 ± 42 min; mean aortic cross-clamp time was 70 ± 27 min. In-hospital mortality was 0%. One patient (3%) required re-thoracotomy for bleeding, one developed a postoperative stroke, and two required ECMO support. Median hospital stay was 9 days. At discharge, 18 patients (45%) were in sinus rhythm; among the 31 who underwent concomitant cryoablation, 16 (52%) were discharged in sinus rhythm. Conclusions: Minimally invasive LAA exclusion is feasible and safe when performed via right minithoracotomy during minimally invasive mitral valve surgery. The technique achieves high rates of successful deployment and avoids the need for additional incisions or access sites. This approach represents a valuable addition to the armamentarium of concomitant stroke prevention strategies in patients with AF undergoing minimally invasive valvular surgery. Full article

Background: Atrial functional mitral regurgitation (AFMR) results from left atrial (LA) remodeling and mitral annular dilation in patients with atrial fibrillation and preserved left ventricular function. While annular dilation is considered the primary mechanism, the role of leaflet morphology in determining regurgitation severity remains incompletely characterized. We hypothesized that leaflet morphology, rather than annular dilation alone, is more strongly correlated with AFMR severity. Methods: We prospectively studied 113 consecutive patients with persistent atrial fibrillation and AFMR who underwent comprehensive three-dimensional transesophageal echocardiography (3D TEE). Mitral valve geometry was analyzed using dedicated software (EchoPAC v.206, 3D MVQ Analysis). Patients were classified according to MR severity: non-significant (grade 0–1) versus moderate or severe (grade 2–3). Logistic regression identified predictors of moderate or severe AFMR. Results: Moderate or severe MR was present in 57 patients (50.4%). Compared with patients with non-significant MR, those with moderate or severe regurgitation exhibited larger annular dimensions (3D annular area 12.7 vs. 11.4 cm², p = 0.005), reduced non-planar angle (145° vs. 149°, p = 0.027), greater leaflet areas, and increased tethering parameters. Anterior leaflet length was markedly greater in the moderate/severe group (2.7 vs. 2.4 cm, p = 0.001). In different multivariable analyses models adjusting for age, sex, LA diameter, and 3D annular area, anterior leaflet length (OR 3.16 per SD, 95% CI 1.65–6.61, p = 0.001), anterior leaflet area (OR 3.42 per SD, 95% CI 1.48–8.74, p = 0.006), and posterior leaflet length (OR 0.39 per SD, 95% CI 0.15–0.86, p = 0.043) remained independently associated with moderate or severe AFMR. ROC analysis demonstrated good discriminative ability for anterior leaflet length (AUC 0.746, with an optimal threshold of 2.55 cm, sensitivity 75%, specificity 68%), and anterior leaflet area (AUC 0.680, and an optimal cut-off value of 5.75 cm², sensitivity 70.2%, specificity of 64.3%). Conclusions: In patients with AFMR, anterior leaflet dimensions assessed by 3D TEE are the strongest independent predictors of moderate or severe regurgitation, outperforming annular parameters. These measurements may represent practical tools for risk stratification and patient selection for intervention. Full article

Background/Objectives: The Ross procedure is recognized for its excellent long-term outcomes in aortic valve surgery, providing superior hemodynamic performance, freedom from anticoagulation, and a low risk of valve thrombosis. The aim of this study was to evaluate the technical feasibility and early clinical outcomes of performing the Ross procedure through a minimally invasive V-shaped (arrow-shaped) partial sternotomy in adult patients. Methods: Eleven consecutive adult patients underwent a Ross procedure through a 7 cm upper midline skin incision and a V-shaped (arrow-shaped) ministernotomy sternotomy extending to the third intercostal space. Cardiopulmonary bypass was established through central cannulation. The pulmonary autograft was implanted in the aortic position using the miniroot technique, followed by implantation of a pulmonary homograft in the pulmonary position. Operative, perioperative, and early echocardiographic outcomes were prospectively evaluated. Results: All procedures were completed successfully without conversion to full sternotomy or major intraoperative complications. The cardiopulmonary bypass and aortic cross-clamp times were consistent across the series, averaging 144 and 86 min, respectively. Intraoperative transesophageal echocardiography confirmed satisfactory function of both the autograft and homograft in all patients. Postoperative recovery was uneventful, with mechanical ventilation times ranging from 4 to 8 h and intensive care unit stays of 24–48 h. No cases of stroke, renal failure, permanent pacemaker implantation, atrial fibrillation, wound infection, sternal instability, reoperation for bleeding, readmission, or mortality occurred. Patients were discharged between postoperative days 7 and 10. At 3-month follow-up, transthoracic echocardiography demonstrated preserved left ventricular function, absence of aortic regurgitation, and low transvalvular gradients in all patients. Conclusions: This initial single-center case series demonstrates the technical feasibility of performing the Ross procedure through a V-shaped (arrow-shaped) partial sternotomy in carefully selected adult patients. The approach provides satisfactory operative exposure for all components of the procedure while maintaining the advantages of minimally invasive surgery. Larger studies with longer follow-up are required to further evaluate clinical outcomes and long-term durability. Full article

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. Full article

Background: The left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation. Current percutaneous LAA occlusion devices require permanent implants. A catheter-based, non-implant mechanical inversion strategy may offer an alternative approach to stroke prevention. Objectives: To assess the feasibility of vacuum-assisted catheter-based inversion of the LAA using transseptal aspiration in a swine model. Methods: A 59-kg domestic swine underwent transseptal access via the right femoral vein under fluoroscopy, transesophageal echocardiography (TEE), and intracardiac echocardiography (ICE). A 22-F aspiration catheter was advanced into the left atrium and positioned at the LAA apex. Negative pressure was generated manually with a 60-mL syringe attached to the aspiration port, and sequential suction–traction maneuvers were performed to induce LAA inversion. Procedural feasibility, hemodynamic stability, imaging changes, and gross pathology were assessed. Results: LAA suction and inversion were feasible. Sequential negative pressure applications resulted in complete inversion, confirmed by multiplane TEE. A mild, non-hemodynamically significant pericardial effusion occurred. Necropsy showed focal apex injury consistent with catheter stiffness and suction forces. Conclusions: Catheter-based vacuum-assisted LAA inversion was technically feasible in this acute swine experiment. However, chronic survival studies are required to evaluate durability of inversion, tissue healing, thrombogenicity, and long-term safety before clinical translation can be considered. Full article

Background: Small animal models are essential for atrial fibrillation (AF) research. Researchers in AF use an electrocardiogram (ECG), echocardiography and invasive electrophysiology study (EPS) to assess atrial structural and electrical remodeling. In relatively smaller cardiac structures and rapid heart rates, the examination can be challenging without special tools designed for animal study. Moreover, conventional invasive EPSs often cause significant trauma, alter autonomic tone, and limit longitudinal evaluations. This study aimed to evaluate the feasibility of repurposing hospital-grade medical devices for the non-invasive, multi-modality assessment of atrial myopathy in a rat model of metabolic syndrome (MetS). Methods: A total of 12 male Sprague-Dawley rats underwent the multi-modality assessment. Structural remodeling was evaluated using hospital-grade echocardiography (8–12 MHz) to measure left atrial (LA) dimensions and volume. Surface ECG was used to determine P-wave duration. Electrical remodeling and AF inducibility were assessed using transesophageal pacing (TEP)-based EPS, evaluating the atrial effective refractory period (AERP), sinus node recovery time (SNRT), and response to rapid atrial burst pacing. Results: The protocols showed high procedural safety (survival rate 91.67%) and successfully characterized atrial myopathy. Surface ECG showed marked intra-atrial conduction delay with prolonged P-wave duration in the MetS group (30.17 ± 4.62 vs. 22.33 ± 1.86 ms, p < 0.05). Echocardiography revealed signs of structural remodeling in the MetS group, evidenced by marked prolonged Isovolumic Relaxation Time (IVRT: 35.602 ± 3.043 vs. 19.187 ± 3.631 ms; p < 0.001) and increased Left Atrial Area (0.223 ± 0.0556 vs. 0.134 ± 0.033; p = 0.007). Furthermore, TEP-based EPS quantified electrical remodeling. The MetS group had shorter AERP (73.33 ± 10.33 ms vs. 120.00 ± 34.06 ms; p = 0.010) and Corrected SNRT (100.67 ± 53.98 ms) versus controls (208.33 ± 76.97 ms; p = 0.018). The MetS group exhibited a higher absolute AF inducibility rate (50%, three out of six rats) compared to the SH group (33.3%, two out of six rats). Conclusions: The integration of surface ECG, echocardiography, and TEP-based EPS provides a safe, highly reproducible, and comprehensive method for evaluating both structural and electrical components of atrial myopathy in small animal models, allowing for robust longitudinal studies. Full article