A Simple Manual Maneuver for Suspected Back-Patch-Related Positional Alerts During Pulsed Field Ablation

of the manual counter-traction maneuver for suspected back-patch-related positional alerts during PFA. Cough-related body movement caused suspected cranial-side back-patch displacement and triggered CARTO positional alerts. Light cranial skin counter-traction was applied opposite to the apparent patch-shift direction without direct contact with the patch. Among 23 alert episodes, 22 were resolved, with a median correction time of 1.62 s and a median measured displacement of 11.69 mm. Pre- and post-alert anatomical maps showed no gross mismatch on visual comparison, although small localization errors cannot be excluded.