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.
Background:
Pulsed field ablation (PFA) using the PulseSelect catheter is effective for atrial fibrillation but may occasionally result in catheter deformation or knotting.
Methods:
We analyzed 25 PulseSelect catheters used for AF ablation to identify knotting mechanisms. Two reproducible knot types were observed. A resolution strategy was tested: retraction to the sheath tip, wire withdrawal, and gradual advancement with or without rotation.
Results:
The knot was resolved in 24 catheters (96%), with 21 (84%) resolved on the first attempt. One severe type 1 knot was resistant but safely removed.
Conclusions:
A structured, non-forceful approach utilizing the catheter's elasticity effectively resolves knotting without rendering the catheter unusable.
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