Environmental Impact of Pentaspline Pulsed Field Ablation-Global Warming or Arctic Front?

from the PERFECT-PAF randomized controlled trial; however, this abstract gives no details on the type of anesthesia used. Moreover, in the UK it is standard practice for pentaspline PFA cases to be performed under general anesthetic using sevoflurane, while CB cases are typically performed under mild conscious sedation using midazolam and fentanyl without any sevoflurane. In our own pub - lished data from an NHS cardiac tertiary center, general anesthesia was utilized in 100% of 208 PFA ablations, but just 10% of 325 CB pro - cedures.3 These data were from our early experience of PFA and given the benefits in terms of procedure time, anecdotally, very few operators would now perform CB under full general anesthetic when PFA could be used instead. Sensitivity analyses by Chun et al did not test for such a scenario; while they ran a simulation for total intravenous anesthetic, this was assumed to be the case in both arms, whereas a simulation reflective of real-world UK practice would need to assume inhaled an- esthetic in 100% of PFA cases but 0% of CB cases. This would almost certainly make CB more environmentally friendly if anesthetic gas is the primary driver. This highlights the need for further research into PFA systems which may be better tolerated under conscious sedation,4 or alternative anesthetic strategies. Overall, while we are enthusiastic about PFA in terms of work - flow, efficiency, and clinical outcomes, we do not believe the statistical modeling in the current study is accurately reflective of UK NHS prac- tice. Efforts to reduce environmental impact of PFA systems would be welcomed. Peter Calvert*, Vishal Luther, and Dhiraj Gupta Department of Cardiology, Liverpool Heart & Chest Hospital Liverpool Centre for Cardiovascular Science at University of Liverpool, John Moores University, Liverpool, UK Disclosures: P .C. has no conflicts to declare. V .L. received support from UK National Institute for Health Research scholarship award, was speaker for Bos - ton Scientific and J&J MedT ech, and received research grants from J&J Med- T ech. D.G. received institutional research grants from J&J MedT ech, Boston Scientific, and Medtronic, and speaker fees from Boston Scientific. *Corresponding author: Email: peter.calvert@lhch.nhs.uk