Acoustic coupling systems and methods are disclosed as these can be used for assessment and ablation procedures. An exemplary acoustic assessment system for a catheter has a flexible catheter shaft. At least one acoustic transducer is positioned in the flexible catheter shaft. The at least one acoustic transducer emits a generated acoustic signal for reflection by adjacent tissue. The at least one acoustic transducer receives a reflected acoustic signal from the adjacent tissue and generates electrical signals corresponding to one or more property of the tissue. An output device is electrically connected to the at least one acoustic transducer. The output device receives the electrical signals and generate output for a user for assessing the tissue.