There were not a lot of these smaller companies at HRS 2021, whether due to economic constraints or the risk of investing in a conference presence that would not meet expectations. However, knowing the limitations to innovation in large corporations, I think this was a great shame: Electrophysiology needs small business innovation. Hopefully, these will be back in 2022.

One exception was the curiously large number of small exhibits promoting patient monitoring equipment: This is reimbursed in addition to and independent of the CMS reimbursement for electrophysiology ablation, so it’s possible the proliferation of these is due to the fact that their technology and service improves patient treatment without reducing the already thin hospital margins on ablation procedures.


If so, that’s great for patient care. But we also really need innovation that reduces costs directly related to the ablation procedure so that hospitals can continue to adopt new and better technology without risking their bottom line.

The large manufacturers
Meanwhile, the large manufacturers continued to massively dominate the HRS conference — in the Scientific Sessions as well as on the exhibit floor. Their presence was comparatively subdued, with large floor settings rather than multistory exhibits, and their engagement seemed overall limited. The new, fanfare-bolstered product launches of the typical HRS conference were largely missing.

There was one major exception to this: Biosense Webster built a large, imposing two-story exhibit with lots and lots of exhibit staff (mostly talking with each other). No doubt the idea was to send the message that Biosense Webster dominates the industry (which it does), but the message sounded a bit hollow in the half-empty exhibit hall where everybody else had a taken a more pandemic approach to their presence.

Biosense Webster’s launch of the Octaray mapping catheter was also the only substantial product launch at the conference. Signs were everywhere, inside and outside the conference hall. The Octaray is a next-generation mapping catheter, intended to improve the performance of the widely-used Pentaray mapping catheter.

Innovation
In terms of innovation overall, HRS 2021 was a bit thin. In scientific sessions, there were interesting and important presentations and discussions around 4D ICE (intra-cardiac echocardiography catheters — ultrasound catheters used in electrophysiology procedures), new mapping methodologies and catheters, and new approaches to electrophysiology diagnoses and ablation. These were mostly dominated by the four large manufacturers and their consultants.

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