The 2019 Heart Rhythm Society scientific sessions: advanced technology in electrophysiology
May 17, 2019
By Lars Thording
The 40th Heart Rhythm Society’s Scientific Sessions brought together manufacturers, clinicians and electrophysiology (EP) leadership to discover and discuss new technology and new techniques in EP procedures. Electrophysiology, a treatment area that addresses the diagnosis and treatment of atrial fibrillation (AF) and similar diagnoses, is expected to grow rapidly in coming years. Due to the high cost of technology involved in EP procedures — and the large volume of procedures expected — this technology conference receives a lot of attention, as the large manufacturers roll out new technologies, clinicians get educated about new opportunities, and providers seek to incorporate them into their operations.
Electrophysiology is proving to be a treatment area with huge opportunities from the perspective of clinical outcomes. Conversely, there are challenges in terms of patient access and procedure efficacy. New technologies are critically important in increasing patient access, increasing efficacy, and reducing procedure time — but they also represent cost increases on a service line that is dealing with some of the costliest equipment and devices of all service lines in the hospital. Some EP lab managers at the 2019 Heart Rhythm Society conference told me that it is a challenge for them to implement new technologies while still remaining profitable. In fact, one EP lab manager’s primary concern was patient access. To paraphrase the manager, “If I adopt these new technologies, most of which really don’t add quantum leaps in clinical efficacy, is it going to be at the cost of being able to provide the procedures for all the patients that could benefit from them?”
With such concerns in mind, a review of the Heart Rhythm Society’s 40th Annual Scientific Sessions needs to include observations that go beyond technological and clinical advances in the field. Technological progress is only as valuable as the hospital’s ability to adopt such advances while reducing costs, increasing access or reducing procedure time. So while it is easy to be fascinated with the impressive technology in this space, as I walked the exhibition floor in San Francisco, I kept asking the question we all should ask: “Does this produce better patient outcome? And if so, does it also allow me to keep solving the cost equation?” These are very real questions, according to some of the EP lab administrators I met at the conference.
As usual, the exhibition floor was dominated by the great global players in electrophysiology: Biosense Webster (Johnson & Johnson), Abbott, Medtronic, and Boston Scientific. The other half of the exhibition floor was inhabited by a lot of small companies with EP innovations, whose primary goal in attending Heart Rhythm Society is to get acquired by the aforementioned industry giants.
Here are four key takeaways from this year’s conference:
Incremental improvements
There were no big announcements or technology reveals at this year’s conference. Incremental improvements in mapping systems, ablation techniques, and high-resolution mapping were topics discussed in the scientific sessions and in the exhibition areas. In fact, two of the biggest exhibitors and technology leaders in electrophysiology, Biosense Webster and Abbott, were presenting last year’s innovations, the Vizigo bi-directional sheath (Biosense Webster) and the Advisor HD mapping catheter (Abbott). This doesn’t mean they’ve stopped developing new technologies. I fully expect their R&D teams are simply busy at work with the next mapping system or ablation catheters. More to come in the next 12 months, I expect.
Breakaway players
Normally, the industry’s four largest companies have a dominant lead in the market, as well as a dominant presence in the exhibition hall, compared to all others. But this year, two companies broke away from the peloton of aspiring players to present something that could eventually challenge the industry leaders.
Philips introduced its EPD Solutions, an open mapping system that the company acquired last year. This will compete with Biosense Webster’s Carto system, Abbott’s EnSite Precision and Boston Scientific’s Rhythmia. Philips doesn’t really offer any EP or ablation catheters, so I am waiting to see if they develop a full solution, either through new device launches or through acquisition or collaboration.
The other company that deserves mention is Acutus Medical, whose exhibit was busy throughout the convention, with clinicians and technologists hearing about the company’s progress in building a full EP solution on an open platform to address both clinical efficacy and cost aspects of EP.
Back in the game
Single-use device reprocessing has come to play a major role in reducing EP procedure costs. In this realm, Stryker Sustainability Solutions announced its FDA clearance to reprocess the single-use ViewFlex diagnostic ultrasound catheter during the conference. This is Stryker’s first new clearance of an EP related catheter since 2013, but it’s a strong sign that Stryker wants to continue to play a role here. (By comparison, reprocessor Innovative Health has received seven clearances in the EP space since the last conference.) Stryker also announced its own introducer sheath.
The right people in the room?
Finally, I’d be hard-pressed to not mention that there were fewer participants at this year’s Heart Rhythm Society conference than there were last year. Specifically, I missed seeing more EP lab managers, directors and technicians, whose task it is to understand these technologies and balance the need for new technologies with the need to remain profitable and allow more patients access to EP procedures. On the other hand, there were plenty of international distributors and leading EP clinicians — not to mention representatives from the exhibiting companies.
As always, I’d like to thank the Heart Rhythm Society for maintaining a high standard for its annual convention, as well as the industry at large for continuing to push the boundaries of EP technology. We need to continue to find a balance between technological advancement, the operational and financial realities of EP lab management, and our common obligation to ensure that effective and efficient technologies are accessible so that as many patients as possible can receive the benefits. Today, when looking at new technologies that usually come with a premium price, we must ask: Who is going to pay for it?
About the Author: Lars Thording, Ph.D., has a background in academia, consulting and industry leadership. He has been responsible for the launch of numerous market-disrupting solutions across healthcare, insurance and technology. Originally from Denmark, Lars has taught at universities in Denmark, Ireland and the United States. He currently serves as the vice president of marketing and public affairs at Innovative Health, a medical device reprocessing company specializing in electrophysiology and cardiology technology. Lars currently serves on the board of the Association of Medical Device Reprocessors.
The 40th Heart Rhythm Society’s Scientific Sessions brought together manufacturers, clinicians and electrophysiology (EP) leadership to discover and discuss new technology and new techniques in EP procedures. Electrophysiology, a treatment area that addresses the diagnosis and treatment of atrial fibrillation (AF) and similar diagnoses, is expected to grow rapidly in coming years. Due to the high cost of technology involved in EP procedures — and the large volume of procedures expected — this technology conference receives a lot of attention, as the large manufacturers roll out new technologies, clinicians get educated about new opportunities, and providers seek to incorporate them into their operations.
Electrophysiology is proving to be a treatment area with huge opportunities from the perspective of clinical outcomes. Conversely, there are challenges in terms of patient access and procedure efficacy. New technologies are critically important in increasing patient access, increasing efficacy, and reducing procedure time — but they also represent cost increases on a service line that is dealing with some of the costliest equipment and devices of all service lines in the hospital. Some EP lab managers at the 2019 Heart Rhythm Society conference told me that it is a challenge for them to implement new technologies while still remaining profitable. In fact, one EP lab manager’s primary concern was patient access. To paraphrase the manager, “If I adopt these new technologies, most of which really don’t add quantum leaps in clinical efficacy, is it going to be at the cost of being able to provide the procedures for all the patients that could benefit from them?”
With such concerns in mind, a review of the Heart Rhythm Society’s 40th Annual Scientific Sessions needs to include observations that go beyond technological and clinical advances in the field. Technological progress is only as valuable as the hospital’s ability to adopt such advances while reducing costs, increasing access or reducing procedure time. So while it is easy to be fascinated with the impressive technology in this space, as I walked the exhibition floor in San Francisco, I kept asking the question we all should ask: “Does this produce better patient outcome? And if so, does it also allow me to keep solving the cost equation?” These are very real questions, according to some of the EP lab administrators I met at the conference.
As usual, the exhibition floor was dominated by the great global players in electrophysiology: Biosense Webster (Johnson & Johnson), Abbott, Medtronic, and Boston Scientific. The other half of the exhibition floor was inhabited by a lot of small companies with EP innovations, whose primary goal in attending Heart Rhythm Society is to get acquired by the aforementioned industry giants.
Incremental improvements
There were no big announcements or technology reveals at this year’s conference. Incremental improvements in mapping systems, ablation techniques, and high-resolution mapping were topics discussed in the scientific sessions and in the exhibition areas. In fact, two of the biggest exhibitors and technology leaders in electrophysiology, Biosense Webster and Abbott, were presenting last year’s innovations, the Vizigo bi-directional sheath (Biosense Webster) and the Advisor HD mapping catheter (Abbott). This doesn’t mean they’ve stopped developing new technologies. I fully expect their R&D teams are simply busy at work with the next mapping system or ablation catheters. More to come in the next 12 months, I expect.
Breakaway players
Normally, the industry’s four largest companies have a dominant lead in the market, as well as a dominant presence in the exhibition hall, compared to all others. But this year, two companies broke away from the peloton of aspiring players to present something that could eventually challenge the industry leaders.
Philips introduced its EPD Solutions, an open mapping system that the company acquired last year. This will compete with Biosense Webster’s Carto system, Abbott’s EnSite Precision and Boston Scientific’s Rhythmia. Philips doesn’t really offer any EP or ablation catheters, so I am waiting to see if they develop a full solution, either through new device launches or through acquisition or collaboration.
The other company that deserves mention is Acutus Medical, whose exhibit was busy throughout the convention, with clinicians and technologists hearing about the company’s progress in building a full EP solution on an open platform to address both clinical efficacy and cost aspects of EP.
Back in the game
Single-use device reprocessing has come to play a major role in reducing EP procedure costs. In this realm, Stryker Sustainability Solutions announced its FDA clearance to reprocess the single-use ViewFlex diagnostic ultrasound catheter during the conference. This is Stryker’s first new clearance of an EP related catheter since 2013, but it’s a strong sign that Stryker wants to continue to play a role here. (By comparison, reprocessor Innovative Health has received seven clearances in the EP space since the last conference.) Stryker also announced its own introducer sheath.
The right people in the room?
Finally, I’d be hard-pressed to not mention that there were fewer participants at this year’s Heart Rhythm Society conference than there were last year. Specifically, I missed seeing more EP lab managers, directors and technicians, whose task it is to understand these technologies and balance the need for new technologies with the need to remain profitable and allow more patients access to EP procedures. On the other hand, there were plenty of international distributors and leading EP clinicians — not to mention representatives from the exhibiting companies.
As always, I’d like to thank the Heart Rhythm Society for maintaining a high standard for its annual convention, as well as the industry at large for continuing to push the boundaries of EP technology. We need to continue to find a balance between technological advancement, the operational and financial realities of EP lab management, and our common obligation to ensure that effective and efficient technologies are accessible so that as many patients as possible can receive the benefits. Today, when looking at new technologies that usually come with a premium price, we must ask: Who is going to pay for it?
Lars Thording