Early Assessment of the Environmental Impact of Pentaspline Pulsed Field Ablation and Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation

Abstract

Background: 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. Objectives: 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. Methods: 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 CO₂ equivalents (kg CO₂eq), 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. Results: The environmental analysis showed that PFA resulted in total emissions of 13899 kg CO₂eq, compared with 16383 kg CO₂eq for CBA (-2483 kg CO₂eq, -15.2%) per 100 patients. Monte Carlo simulation results confirmed these findings, showing median savings of 2409 kg CO₂eq (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 -4640 kg (-25%). In Germany, for example, with approximately 24000 CBA procedures annually, PFA adoption was projected to reduce emissions by 509723 kg CO₂eq. Discussion: PFA showed potential for reducing emissions by approximately 25 kg CO₂eq 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. Conclusions: 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.