Managing Catheter Knotting in Pulse-Select Pulsed Field Ablation: Mechanisms and a Practical Strategy for Resolution.
Masateru Takigawa1,2, Ryosuke Kato1, Masaki Honda1
1Department of Cardiovascular Medicine Institute of Science Tokyo Tokyo Japan.
Journal of Arrhythmia
|March 23, 2026
Summary
Pulsed field ablation (PFA) catheters can knot during atrial fibrillation procedures. A structured retraction and advancement technique successfully resolved knots in 96% of cases, preserving catheter usability.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Pulsed field ablation (PFA) is an effective treatment for atrial fibrillation.
- The PulseSelect catheter, used for PFA, may occasionally deform or knot during procedures.
Purpose of the Study:
- To analyze knotting mechanisms in PulseSelect catheters during atrial fibrillation ablation.
- To evaluate a resolution strategy for catheter knotting.
Main Methods:
- Analysis of 25 PulseSelect catheters used for atrial fibrillation ablation.
- Identification of two reproducible knot types.
- Testing a resolution strategy involving sheath retraction, wire withdrawal, and controlled advancement.
Main Results:
- Knotting was resolved in 24 out of 25 catheters (96%).
- Successful resolution on the first attempt was achieved in 84% of cases (21 catheters).
- One severe knot type was resistant but safely removed.
Conclusions:
- A structured, non-forceful approach effectively resolves PulseSelect catheter knotting.
- The described strategy utilizes the catheter's elasticity and preserves its usability.
- This method enhances the safety and reliability of PFA procedures.
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