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The 2019 Heart Rhythm Society scientific sessions: advanced technology in electrophysiology

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.

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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.

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