Introduction: Atrial fibrillation is the most common cardiac arrhythmia. The development of electroanatomical mapping is an increase demand for advanced intracardiac imaging techniques of the left atrium and pulmonary veins. IVUS can demonstrate quantitative changes like lumen and wall thickness as well as qualitative changes of the pulmonary wall. IVUS could also provide relevant real time imaging of the atrial and pulmonary venous wall during catheter ablation.Areas covered: The Medline and Embase databases were searched for preclinical and clinical studies of IVUS in patients with ablation of atrial fibrillation or left atrial arrhythmias. This article reviews the 15years of preclinical and clinical experience with IVUS evaluating the pulmonary veins.Expert commentary: IVUS has proven to be a valuable imaging technique in the management of atrial fibrillation ablation. The understanding of the relation between morphological changes and functional results of catheter ablation, combined with the safety profile have made it appealing for interventionists.