{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:11:54Z","timestamp":1779394314424,"version":"3.53.1"},"reference-count":50,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Atrial fibrillation (AF) affects 2% to 4.5% of the population. Catheter ablation, a key strategy for paroxysmal AF management, can be achieved through radiofrequency (RFA), cryoablation (CBA), or pulsed field ablation (PFA). While clinical outcomes are well studied, their environmental impact remains underexplored.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This study modeled the environmental impact of CBA and PFA ablation techniques in Europe, aiming to provide evidence to guide sustainable practices in AF treatment.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n An early environmental analysis compared pentaspline PFA (Farapulse system, Boston Scientific) with CBA using a decision-analytic model. The model simulated the patient care pathway from a hospital perspective over a 1-year time horizon, considering index and redo procedures, and complications. The environmental impact, linked to resource use, was measured in kilograms of CO\n 2<\/jats:sub>\n equivalents (kg CO\n 2eq<\/jats:sub>\n ), incorporating length of stay, intervention time, anesthetic use, and complications. Probabilistic and scenario analyses, including a comparison with RFA, were performed to assess uncertainty and robustness of the results.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The environmental analysis showed that PFA resulted in total emissions of 13\u2009899 kg CO\n 2eq<\/jats:sub>\n , compared with 16\u2009383 kg CO\n 2eq<\/jats:sub>\n for CBA (\u22122483 kg CO\n 2eq<\/jats:sub>\n , \u221215.2%) per 100 patients. Monte Carlo simulation results confirmed these findings, showing median savings of 2409 kg CO\n 2eq<\/jats:sub>\n (95% credible interval: 581-4312 kg). Parameters, such as anesthesia time and anesthetic drug use, were key drivers of the results. In the RFA scenario analysis, PFA yielded a saving potential of \u22124640 kg (\u221225%). In Germany, for example, with approximately 24\u2009000 CBA procedures annually, PFA adoption was projected to reduce emissions by 509\u2009723 kg CO\n 2eq<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n \n PFA showed potential for reducing emissions by approximately 25 kg CO\n 2eq<\/jats:sub>\n per patient compared with CBA, driven by lower resource use. These findings aligned with studies identifying operating rooms and anesthetic drug use as major contributors to hospital emissions. A study limitation was the lack of data on catheter manufacturing and disposal.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n PFA was expected to reduce emissions compared with CBA in AF patients. Conscious medical device choices can foster more sustainable hospital practices. A full life-cycle analysis of catheters is needed to validate these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.36469\/001c.151216","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:39:43Z","timestamp":1765809583000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Early Assessment of the Environmental Impact of Pentaspline Pulsed Field Ablation and Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation"],"prefix":"10.36469","volume":"12","author":[{"given":"Julian","family":"Chun","sequence":"first","affiliation":[{"name":"CCB \u2013 Medizinisches Versorgungszentrum Frankfurt und Main-Taunus GbR, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Schmidt","sequence":"additional","affiliation":[{"name":"CCB \u2013 Medizinisches Versorgungszentrum Frankfurt und Main-Taunus GbR, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Timmermanns","sequence":"additional","affiliation":[{"name":"CCB \u2013 Medizinisches Versorgungszentrum Frankfurt und Main-Taunus GbR, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Uffenorde","sequence":"additional","affiliation":[{"name":"Boston Scientific Medizintechnik GmbH, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Fern\u00e1ndez-Barcel\u00f3","sequence":"additional","affiliation":[{"name":"Coreva Scientific GmbH & Co. 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KG, Koenigswinter, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Brooke","sequence":"additional","affiliation":[{"name":"Boston Scientific Limited, Hemel Hempstead, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Giovanni","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Universitair Ziekenhuis Brussels, Belgium","department":["Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"publisher","first-page":"2039","DOI":"10.1093\/europace\/euab154","article-title":"Worldwide sedation strategies for atrial fibrillation ablation: current status and evolution over the last decade","volume":"23","author":"R. 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