Given that electrophysiology is one of the fastest-growing areas of healthcare, it’s critical for any leaders in this industry to keep pace with trends as well as both the clinical and technical advancements taking place in this sector. However, it can be difficult to consistently review the volumes of new clinical studies and attend every scientific and industry event available to healthcare professionals today. For those of you who could not attend the Heart Rhythm Society’s 39th annual meeting last month in Boston that brings together cardiac arrhythmia professionals and experts in the electrophysiology industry, the following were a few of the takeaways and insights gained from the recent event.
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Knowledge Sharing and Clinical Studies
One of the most anticipated sessions at the event was a detailed dive into the latest evidence-based study comparing the effectiveness of early AF Ablation versus drug treatment – the Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) study. Unfortunately, the study failed to produce the hoped-for results that early intervention in Atrial Fibrillation (AF) with AF Ablation is more effective than pharmaceutical treatment in terms of mortality rates.
However, results revealed that in patients with atrial fibrillation, catheter ablation conferred better outcomes compared with drug therapy in on-treatment and per-protocol analyses, but not in an intention-to-treat analysis. The difference in these two analyses was attributed to the fact that nearly 30 percent of patients receiving drug therapy eventually ended up receiving ablation, and nearly 10 percent of patients assigned to ablation didn’t actually undergo the procedure. These results were shared by Douglas L. Packer, MD, professor of medicine and consultant in the division of heart rhythm services in the department of cardiovascular medicine, at Mayo Clinic.
While the secondary endpoint pointed to AF Ablation vs drug treatment, many physicians were less focused on this and did not see much new in the results. That’s because AF Ablation is already a widely celebrated innovation in AF treatment, an option that clinicians are excited about since, in contrast to drugs, this represents a curative option.
A Four-Player Industry
More than half the exhibit floor was occupied by the four large players in the Electrophysiology device industry – Medtronic, Philips, Biosense Webster (Johnson & Johnson) and Abbott. These companies have been responsible for a phenomenal string of technology developments over the past decades, a development that has brought high quality, sophisticated devices and consoles to the area. This has enabled a small revolution in electrophysiology and made procedures like AF ablation available.
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The remainder of the floor space was inhabited by smaller booths with less glamor and a strong flavor of technology start-ups: Exhibits focusing on a singular innovation, some with very promising ideas that, if commercialized, would enhance the treatment efficacy or safety. Commercialization is the big “if” for innovation in this industry. It is typically achieved through acquisition by the aforementioned four big players. Not surprisingly, half the exhibit floor was occupied by startups wanting to be acquired by the other half of the exhibit floor. It would have been comforting to see a third “village” of medium-sized companies with the potential to shake up the space and provide more choice and more organic growth in the future.
Innovations
Exhibitors showcased this year’s innovation: New patient monitoring devices were numerous, and the large manufacturers dedicated their space to the introduction of their newest sheaths and catheters: Biosense Webster focused on their newest introducer sheath, the Vizigo, which limits patient exposure to radiation; Baylis presented a new steerable sheath to go with their transseptal needle; and Abbott introduced the Advisor HD, a mapping catheter that competes directly with the Biosense Webster Pentaray catheter, and is a non-lasso version of their original Advisor FL. The summary observation from a walk through the large manufacturers’ offering is that they are all creating devices to complete their portfolio, so all key devices necessary for an AF Ablation case can be found from one manufacturer.
At the same time, there was less focus on the introduction of consoles and other capital equipment, something that has dominated the conference in recent years.
New catheters are needed to increase safety and efficacy of procedures, but there is a need for more than incremental improvements if the promises of AF Ablation are to come true: Procedure growth is limited by the high cost of devices and procedure complexity, resulting in limited access. To advance AF Ablation beyond its current promising beginnings, innovation is needed that focuses on reducing costs while dramatically improving outcome.
An exception to the focus on new device innovation was the presence of two companies from the single-use device reprocessing industry, an industry that in the past has succeeded in getting hospitals to a better cost equation by offering reprocessed devices with FDA-backed parity safety and functionality. Relying on such devices will help the big four players realize the potential of their technology achievements in terms of making treatment more affordable and accessible.
Electrophysiologists, healthcare economics and single-use device reprocessing
Thousands of clinicians, scientists, researchers and innovators from around the world gathered together for this 5-day event at the Boston Convention and Exhibition Center. In the past, many nurses and technicians from EP Labs across the country would attend, but this conference is increasingly dominated by electrophysiologists. Although financial pressure undoubtedly played a role in this shift in attendance, given the important clinical knowledge and best practices shared between private organizations, leading hospitals, manufacturers and non-profit organizations, I think we can expect that physicians will continue to find value in this event year after year. Cost cutting measures aside, one of the best ways to foster innovation is to bring the great clinical minds of our generation together to share real-world practices and success.
Photo: hudiemm, Getty Images
Lars Thording, PhD, serves as vice president of marketing and public affairs at Innovative Health LLC. He 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, Thording 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.
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