No, of course it doesn't have to be an air-to-air heat pump. The problem is just that the prefabricated house builders I have been in contact with so far install this technology without an extra charge, and for the air-to-water heat pump with underfloor heating they add 15-20 thousand on top. I am currently very uncertain between the marketing promises of this system (sufficient at 40+, you need a ventilation system anyway, allergy-friendly, cost-effective..) and my own doubts/warnings on the internet (dry air, cold rooms, high electricity consumption, you commit to this technology for a long time). I recently attended a consultation in a show house with an air-to-air heat pump and despite wearing contact lenses I didn’t have dry eyes. Maybe it’s not all so bad after all, or perhaps a few hours were not enough to judge... In gathering information, I just get the feeling that there are pure "supporters" and "rejecters." I have made an appointment with an energy consultant, maybe he can advise me a bit more objectively... And of course I gladly welcome help here from the forum..