Let's officially begin this roundtable. I'm Dr. Paul Zai. You can all call me Paul, as I said earlier. And this is a very exciting session. This is the EP Lab of the Future. So this is a time for us to sort of brainstorm and dream, I guess, and think about what, you know, going beyond what we do day to day today. And to do that, we have, I think, an amazing panel here. Maybe everyone can make a very quick introduction. But I'll say to start off with this, I think we've assembled a panel that are of folks doing things that are currently sort of making a big difference in advancing our EP Lab sort of workflow in the future, and then in the future as well, advancing it in the next years to come. So maybe start down at the end. Matt Smith-Eisen, CEO of CathVision. I'm Dan Guerrero. I'm the Director of Clinical Affairs for U.S. Clinical for Volta Medical. Shlomo Shpun, Chief Scientific Officer for Tech World Holding. David Fischel, the CEO of Steritaxis. Liat Tsarev, Senior Director of Digital AI and R&D Collaborations from J&J MedTech Electrophysiology. Burt Toss, the CEO of CentiAR. Hey, everyone. Kyle Newman. I'm the Program Manager for Afera at Medtronic. All right. So a couple of just, I guess, for the audience as well, the ground rules. I think you have all, the panelists have all heard a little bit. My goal is to keep this a very open discussion. You all have your particular expertise and interests, and I think we want to all hear about your perspective coming from there about how you envision so-called the EP Lab of the future. But I want to keep this a very broad discussion and have everyone have a chance to chime in on whatever they want to as well, and we'll take it also where the discussion goes. A couple of just general, I guess, ground rules I would like to see is, number one, let's think about, I think, how do you define the future, right? Is the future tomorrow, what we're doing in the lab when we get back to the lab, or is it next year based on what may or may not get approved by regulatory agencies as was discussed in the same table earlier? Or is it five years from now, or your vision for 10 years from now? Are we even going to have an EP Lab in 10 years because we will have cured AFib and VT or something? I don't know. But anyway, so think about it that way. The second thing I want to have everyone keep in mind as well is, of course, think about the stakeholders aside from, you know, here we have a physician, we have folks from industry, but then we also have the hospital, we have society at large and the financial considerations. We have the patient, of course, is most important, is what the patient experiences. And I would emphasize that because when I say EP Lab, I also think about the whole process. So it's not just the minute they get wheeled into the room and then the minute they wheeled out of the room, but also some of the areas that I think are just as important for a patient experience outside of those two steps. So taking that from there, I don't know if anyone wants to start with a comment or a question. If not, I can also get the ball rolling too. Maybe I can start. First, I'd like to say that, you know, looking at electrophysiology, it's one of the, I mean, for me, it's one of the best fields that we have in medicine. And you know, if I'm thinking about 30 years ago, how electrophysiology looked like before, you know, mapping and navigation technologies came into the field, it was a totally different world. Before them, we had a lot of innovation coming in, but it doesn't reach any kind of saturation. It's just keep evolving. And innovation is really entering the field at a much even higher pace. So you know, you're talking about the future. So on one hand, you know, innovation is accelerating, but still, at least for me, the future is 10 years ahead. I mean, we are going to see a lot of changes in the electrophysiology lab, but it will take some time, mainly because the medical field is a more conservative field and it takes time until innovation gets really into the market and becomes practical. Now one major change that I believe that we'll see when we talk about the EP lab. So today the EP lab is kind of constrained into an office, some geographical place, a very specific one. I think that talking about a future, when we talk about the EP lab, we should probably think in a more comprehensive way, starting from prior to the procedure, you know, pre-planning of the procedure, procedure itself, and following the procedure, the monitoring of the patient. So we really need to think in a more comprehensive way. I think that's a very good point, and I think that's exactly what I'm talking about as well as beyond the wheels in, wheels out is, you know, I think we're already doing a little bit of that. As you all may be familiar with, there are already data on using, for example, ways to monitor patients afterwards. But also, you know, how can we leverage things, I mean, so much of this meeting is talking about machine learning, AI, how can we use those types of tools to select the best patients for the procedure, or even before they come into the lab, whether it's through imaging or other clinical data, decide which, what kind of an approach you're going to take. Is this patient best off with PFA or with standard RF or with persistence, for example? Are we going to think about additional approaches for ablation strategies that might be more beneficial based on something before they even get into the lab? I think that's a very good point, absolutely. I think one thing to add to that is the location of the ablation seems to be in question as well. Specifically, are we doing it in a fully staffed hospital or a clinic, or are we doing it in ambulatory surgical centers? There's quite an active discussion that's physician-driven on this, and Paul, as you were saying, physicians are a key stakeholder, but it also affects the patient journey, right? Having access to ablations that are not necessarily congregated in major areas, it's a big deal. It's a big need. So as we talk about the place of technology, I think that's another tailwind for the field. I agree with Liat. It's a fascinating field to be in. I think we're very fortunate to serve this field. I wanted to add that angle to it, too. As we think about technology, I think our job is to make this accessible because the procedure is effective, and it's a curative procedure, and it should be accessed by as many people as possible. So that's another angle I think that is probably important as we discuss this. Yeah, those are good points as well. It brings up a couple of things of personal interest to me, as you all may know. So one of the things that I've worked on and advocated for for many years now is performing these procedures without fluoroscopy. And so, for example, if you've seen, there's a paper out of China that's actually advocating for building entire EP labs without installing a fluoro unit in. And if you take that a next step further, can you do this in some kind of a almost office suite kind of a situation? Are we getting to that point eventually in the future? And it's not just to be cool about it or to do it without x-ray, as everyone's talked about here and there, but it's also that idea of can you now do things remotely in a location that doesn't necessarily have some of that infrastructure? And then add on top of that, there's also work going on right now, as you may all know, of remote mapping, remote assistance, and all that kind of stuff. And speaking of all that, I think this may be a good point to bring David into the discussion as well with the idea of stereotaxis on the one hand is it centers around a large piece of equipment that's an installed expensive piece of hardware, but it also allows for the possibility of more remote kind of procedure. So it's an interesting, I think, dichotomy or conundrum or however you want to put it. I'd love to hear your thoughts about how that fits into that future vision. Sure. When you were talking, obviously, scope, we could talk about a full range from pre-op, op, post-op. You can think about the kind of Western university-style hospitals like yours to remote regions. You can really kind of span everything. I think when I was thinking about the scope of perhaps a discussion, it was in a little bit to what Liat was saying, but I wasn't thinking 10 years out. I was thinking, what can we do today that would be very beneficial today? It might take 10 years because medicine generally evolves very slowly, but what is actionable today in a real sense, and HRX is really meant to be focused on the digital aspects of medicine. Generally, I came into the EP field relatively completely new TP a few years ago. You kind of enter into lab and what is, I think the kind of what surprised me the most is first how cognitive of a profession it is. It is an extremely cognitive procedure, and then how much disparate data, how confusing it is. There's many, many systems. As a physician, you have to kind of try to make sense of all the disparate data. There's not really integration between all the different data points, and so that's kind of how I observed it. I think robots play a particularly helpful role in serving as that central ecosystem where you do have to bring together disparate information. The robot has to be able to synthesize it, help the physician understand it, then help the physician drive the procedure through it, and so it does serve as this kind of central foundation for a digital ecosystem, a digital lab. On the question of remote surgery, though, if we're kind of going to that specific question, I was just actually speaking with a group here at HRS earlier this year. We had the opportunity to present at the Africa Symposium at HRS, and we talked actually about the concept of as you make the robot more and more mobile, and we just got C-Mark for a new robot that is very easy to move around and to install, you can start to think about the model of putting it on a truck, having it go to different locations. You can have a network of VPs around the world that are putting in their cognitive skill set and kind of applying that even in locations thousands of miles away, and so I think that that kind of model does become more and more realistic as you have accessible technology. That's great. Please. So, I want to be, I didn't hear everybody here, but I want to be a little bit provocative. The future is here, not tomorrow, today, and the fact that those people are the technology around the table are speaking for itself, but I have to tell you that 25, even more years ago when we started with the cartel system, nobody had envisioned or nobody had the crystal ball that it will end up 25 years later in this situation, okay? So the reason I'm saying that the future is here today is because of the fact that those people around the table have already, maybe not perfect, but have already a technology that will enhance the catalog of the future. Now, we can speculate, and this is being recorded, and everybody who says here something that will predict something, I'm going to call them in 10 years to see that this came true, so be careful of dreaming here, but I want to say one thing regarding the future catalog. The technologies are already there, it's not perfect because of the fact that different companies are putting a commercial thinking into their way of bringing this technology to the table. At the end of the day, those are commercial companies, they need to create, and you alluded Paul to it, that it will at a certain point in time become a burden because of the fact that the costs are going up, the devices coming in are more and more expensive, and so on. But what turned out to be is that at the end of the day, there is the position, and the position is the one who really controls what piece of equipment will come in and what not. Okay? So, you mentioned the Fluro, the Chinese company who's mentioned. I grew up with this, and this was the dream to create a system that will be Fluro-less, but then comes the human factor, and the human factor means that when you're driving your car, you constantly tend to look at the back mirror to give you a point of safety, and then many years ago, I realized that even with a good system like the Carta is, and the other system as well, the physician needs constantly to press the Fluro pedal to check the back mirror, and that back mirror, I didn't see yet a car with no back mirror. So when the cars will get rid of the back mirror, I believe that people will let Fluroscopy go. I'll stop here because I can go on. All right. So with your analogy, then, what is getting rear-ended in the EP lab? I don't know. Perforations. Yeah. Perforations. No, it's a matter of most of the physician are trained to use Fluoroscopy and three-dimensional mapping system, but every time they lose a little bit the three-dimensional comprehension on a 2D screen, first thing they do, they press the Fluro pedal. Absolutely, absolutely right. And I've experienced that in sort of trying to disseminate all of this myself, and it's a really great point because I think, maybe let me generalize your point a little bit to whoever else wants to chime in on this, is that I think we as physicians indeed are important stakeholders, and in some ways, for better or for worse, yes, we control what gets into the EP lab, as you like to say, and a lot of it's driven by, there's always inertia, there's always feeling like you want to do things the way you're very comfortable with it, and that's a natural human instinct, and I think almost across the board here, you are all doing things that have to disrupt the physician's way of thinking about how they do things, whether it's putting on a set of VR glasses, or using PFA in a different way, or using a different set of electrograms to look at, whatever it is. So I'd love to hear what your thoughts are about how to achieve that, I mean, because this is a personal question for me, because how do you teach an old dog new tricks, I guess. So I think, as an AI company, and with a lot of the buzzword of AI being used around a lot, I think a lot of what we do is we try and use the AI systems, but then bring it back to the operators. And so we can actually use explainable AI models to show you, okay, we used AI, but we can work backwards now and show you the AI picked up on these factors that you can then take back to a clinician and say, so these are what it's looking at, which then allows you to then try and use your physician mind and training to say, okay, well, that's why that might be important. And I think that's going to be key for the adoption of any new technology, is bringing it back to the physician and saying, this is better, and here's why, and then trying to continue to make that case for how it's going to be better, and then bringing it back to a clinical perspective. So one way of saying that is, it's not just the technology, but psychology too? Yes, absolutely. You've got to be comfortable with it. Also, I think once you have clinical benefit, and I think probably no technology should make it if it has no benefit, right? It's a given, so it's kind of silly to say that. But then once you start to continually prove there's benefit, then there's a whole gauntlet of how does it help the administration, the hospital's margin preservation, right? Every hospital is very much struggling. We get this question all the time, you're adding cost, essentially every technology when it's new is adding cost. So there's a whole slew of questions on how do you justify that cost? Who's maintaining this? What is it like for the hospital to think ahead of time when they buy your technology? Now that they buy into a platform, they're going to continue to spend 50, 100K every year just to maintain. What is it like when they want to adopt something new? How does it change their power dynamics with the large strategics? Because they're trying to negotiate contracts with everybody, right? So there's so many facets to this. And I think, Paul, to your question, I don't have an answer. I think what I do have is a checklist of things that a new technology is going to have to check and do it not once, so many times with multiple hospitals to actually be able to stick and stay. So there's quite a high bar. That's a really great point. And I think I've heard this already in several of the different discussions already today is we're sort of at this point with PFA we're facing right now, right? So everyone loves PFA. It's so simple to use. It's quick. It's simple. It's stuff we all hear about all the time. It seems to be safer. But the cost issue, right? And so how do you justify that? And that's, I think, a really, I think we're facing that as a really good example right now. I'd love to hear your thoughts on how to address that. Yeah, I think it's a great point. We definitely are leaning that it is safer. And at the end of the day, that's what gives peace of mind to physicians when you're introducing new technology. I think you're talking about an old dog and new tricks. It has to start with something that is safer for physicians, but also giving them peace of mind during these procedures. Using PFA, you see physicians, they're on the back wall and for the first time their blood pressure isn't spiking, their heart rate isn't rising because they feel safer on that back wall, right? But in terms of the cost, you know, as we continue to develop these things, I think we're going to continue to see more benefits from PFA that we didn't see before. If you look back to the beginning of RF and how much things have evolved, even with, if you take a certain technology, like say the STSF, for example, that first study, if you look at results from then to today, it's dramatically improved. It's the same exact technology, but physicians have learned how to use it better. They have better tools. So I think the benefits of PFA at this price point, we don't know what all those benefits will be. And as we keep driving with innovation, hopefully we'll continue to add to those benefits, being safety outcomes, all of the above. That's a good point as well. Sorry, Beate. I just wanted to add that ablation technology is super important, of course. Having PFA in the market will accelerate, I believe, the treatments and the market in general. But, you know, even with, you know, you gave the example of RF and the STSF, you know, the real jump in performance was when some kind of internal monitoring technologies came in. So I'm talking about the ablation index, for example, capability. We currently don't have that in PFA, but I'm sure that as that will come into the market, performance will even, you know, be of length. Yeah, just as a small important aside on PFA is, I think we are, I mean, we're probably at the same point and equivalent point in RF went before we had irrigation, before we had contact force sensing, before we had index, all of that. And so it'll likely only continue to go upwards in terms of benefit. I want to go back a little bit to the psychological factor of a physician using those technologies. And excuse me that I disagree with the factor of the cost for a second, because the main issue when you get into a cat lab is the physician has a certain expertise, a certain experience, and he's treating his patients according to his workflow. The moment you elevate his feeling that he's doing a much better case, and this is where the safety of PFA is, but I can tell you PFA will not be adopted by those guys that claim that they have zero complications with radiofrequency or with cryo. So from that point of view, the safety is one thing. But if the significant benefit, and I'm saying significant benefit is a very subjective thing, something that you will see a benefit in it, somebody else will not and then it becomes a personal issue will that physician use this new technology although it costs triple. I can tell you from the very early days of Carto again and sorry I'm using history here for example but a Carto catheter at that point in time the first catheter that came out with the sensor was about $1,800 don't catch me on the number but Cordis sold their EP catheters including their ablation five catheters for the price of one single Carto catheter and guess what happened because Carto brought the benefit this was adopted although it was very costly so again perspective of what's the benefit cost in related I don't doubt that and I think from a physician's perspective I would say until recently that's been probably the primary outlook and approach but I think this is maybe with the first time I am hearing in you know around the country of the first time physicians are coming up to a barrier where the hospital will say hey this is starting to get too expensive and so I think there will be a practical issue there that will serve but up against our sort of I think more lofty goals of trying to do what's best for the patient and no cost aside I suggest we take the conversation in the direction of the EP lab of the future back to your your comment around more and more data using data science from my perspective the true existential needs or questions are how do you deliver the right dose of energy not too much not too little irrespective of source and how do you select the right patient for the right treatment approach without bombing the atrium in the case of persistent AF and I'm very passionate that we have a way to go or that we can do a much better job and we should do a much better job in aggregating data across systems across hospitals across labs and that we can get to a much better patient selection and a not much better outcome and safety in the future by combining data and so my vision is that we soon build a manifest I think both academia and industry to both help on how we in the future read studies on 100,000 patients not 1000 patients and I think we need to do something on orders of magnitude bigger to get to the accuracy levels and the improvements we need so thank you that I love that comment that is that is probably my favorite comment today so far because it's exactly also aligned with what I'm very passionate about I think you know we've talked I've given talks with this exact slide is that we collect so much data in the EP lab and just clinically as well and the vast vast majority that just goes to waste we just don't think about it anymore it's stored in some storage and some hard drive or something and it's it's a wasted opportunity and we can learn so much from that we're starting to see that of course in many other aspects of medicine and in cardiology and even an EP but I think specifically with the EP lab we barely scratched the surface yeah you know so I think it's a really good point and it's certainly something that you know I we at Volta have been going through an elaborate effort of trying to increase the amount of data that we take in because as with any system the more data you have the better it gets and I think that's been one of the central challenges that we've found is that hospitals don't exactly know what to do with that you know they they understand that we're making that we're making a product and they're you know and so therefore as we should we should be paying and investing back in those hot in those centers but understanding that like you know even we need hundreds of thousands or at least thousands of patients and having you know one patient and equate to a single value becomes very problematic trying to dig it all the way down to what is the value of a single patient it's not exactly helpful because you need you need the breadth of a database even having you know a thousand patients at one hospital is even still equally problematic because it's only treating this one particular area one particular demographic and so I think it's just a it's a central challenge I know we've we've run across very significantly in trying to how do we expand this how do we get hospitals to partner with us without saying well but you're gonna have to pay us you know a ton of money that makes the project the project completely not feasible absolutely and I know the I can probably also attest to her experience with that similar kind of an issue and anyone that's working with a data-based kind of an approach but I think that that lofty goal that that Mads you mentioned is I think just I think that should be what we're looking forward to or hoping to achieve is is overcoming these I think overcomable barriers to try to aggregate data across hospitals across countries hopefully even and and use that power the power of that data to learn more about how we approach the patient in the best way possible there are real challenges though I think beyond this idea of what a hospital how a hospital views that data on a per patient basis but there's also the issue of perceived data privacy and and and that sort of thing it's a real challenge when thinking about the EP lab of the future and thanks Mads for pulling us back to this that was the four things that I thought that kind of could make an EP lab much much more effective is integration data insights connectivity and and how do you make it a more cognitive profession reducing the mechanical aspect adding to the cognitive side and so I think one thing that would be very very nice and helpful and this Shlomo mentioned it briefly is if there was more integration between the disparate systems if companies didn't create walls between their systems and you had API's that made it standardized I know that the FDA in the diabetes division helped facilitate kind of API's that made CGM and pumps be able to speak together kind of in a fairly straightforward fashion unfortunately we don't have the same thing let's say with mapping systems and recording systems where they all speak a car around a centralized API's we implemented on our robot an open API for open mapping to integrate with mapping systems and preoperative imaging systems and I think that generally we published it publicly we'd be delighted to see kind of the EP community kind of come together to create open and open API's that allow for integration the data analysis that's the tough tough thing you can have huge amounts of data but how to glean insights from data that's the tough tough thing once you have open API's it does facilitate other companies to have access to data where they can then add that insight and so I think again the data side turning data into insight will be very very tough but open integration will facilitate that and allow new entrants to come up with ways to to help connectivity I think it's we're stuck in the EP lab you're alone with only your staff who's there if you can kind of this was the biggest innovation of the last 20 years right if you can make EP labs connected it would be great and then the more that you kind of give physicians cognitive benefits and you take away the fact that they have to stand holding their body in specific positions and this you allow them to focus on the cognitive side of the profession rather than the mechanical side yeah that's a good good point as well because I think in the end at least I would say the vast majority of EPS have this they love the profession because it is there is a nice balance between that mechanical side and the cognitive side and I think perhaps especially with AF ablation it's tipped a little bit too much I would say almost to a mechanical procedure and I think we that's why we love when we have technologies that look at signals because that gets back to our roots you know and I think it's not just the psychology part of it but I think that's what really gets us excited intellectually so so I think anything that encourages that I think will be well received and I think the field so maybe just adding to what was said here and I think that you all said very you know rightfully that you know collecting the data is one of the challenges and what we're trying to do with the cartel is that we want to have Carter data more accessible by using carton it so carton it is a cloud solution where cases of Carter can be uploaded to and the information that lies in in Carto can be more accessible to researchers so this is you know at least one way of having data more accessible still it's a partial way it's a it's kind of a partial solution because data or information that is being collected in the lab is much more than that what we have just in Carto you know we have imaging modalities we have other type of information that is and that's still very you know still needs to be collected in order to to be later on analyzed so there will need to be a lot of collaboration between companies industry and hospitals and researchers so that these are things that they still need to be developed and maybe to add to that there's a lot of things in the lab that need to be collected that maybe aren't being collected but when you look at all these data points we take in from mapping systems and ablation systems you can say oh do we think we had a good lesion set do we have these different things but in the mass mass majority of cases the mapping system and that data it's collecting never sees anything about the outcome of the patient the physician knows about the outcome of the patient and they know what's going well and what's not but we can only do so much with data from in the case if we don't know about what happened to the patient afterwards and thanks for plugging our registries that we've been working on for the last several years so so I think that's exactly right and we you know my vision for what might the little area that we all work on is is you have that large data set collection within the procedure itself but then you take that and you filter or layer it on top of outcomes data which is what we've done with our registry data and then that gives you the power but you know we're we're only still you know a fraction of what's done out there and I think to what everyone's saying here is if we can then just take it to the next level of data collection I think that would really be quite powerful I will actually I guess I'll add a word of caution though because I think data and medicine is is messy right I think that's gonna be some another problem we're gonna have to figure out how to solve is that it's heterogeneous depending on how you collect it the patients are by nature heterogeneous a fib itself is heterogeneous how do you apply the data correctly or in a boy that that actually gives you an answer that's meaningful it's not it's the whole idea of junk in junk out kind of a thing you want to make sure we avoid that Paul I you know I'm very much aligned with what you said and just wanted to add another challenge to data collection so you know with studies large studies we're collecting data but it takes us all of us years to collect the data but until we you know collect the data then new technologies coming to the market and that data is not being collected and the old technologies are you know not relevant anymore so that's another challenge that it takes a long time to collect the data but the technology is advancing quickly that's why these real-world registries like we do I think are so helpful because they they've been designed to be nimble enough so that they can just rapidly incorporate new data I mean just as an example our register our relay of registry has for five years been collecting RF data and now now that we have PF data we're starting to collect that right away it doesn't take much is not like then designing an RCT that or even an ID that you have to run and and all of that kind of stuff so that's an aside but I think we are starting to approach the last 10 minutes or so so first of all any any particular points anyone else wants to make sure to bring up I just wanted to add that I think in the years to come there will be companies fully focused on electrograms and analytics and algorithms we have a few here including my own and Walter and others here and I think it's a paradigm shift because the mapping systems have a very well functional business model where the business is driven by sensors and disposables and it's not been so attractive to do data science on electrograms which I think is still the closest fingerprint to the disease we have and to the to the EP so I think it it looks more bright because I think there can be some conflicted interest in business in the classic Giants in our space so I think there is a bright future for for electrograms and and for data science and yeah I just want to add that Schlummer is not agreeing come on tell me no no it's not that I don't agree the fact is and I agree with Paul and I agree with you at the end of the day EP is electrograms but this will not make a future leap until the electrograms really will benefit the practitioner he will have instead of looking look instead of looking on a paper chart that had 12 15 channels now it's colors but the colors are not enough we need the signals and the signal interpretation that will denote the physician this is the arrhythmia this is the place of the source or those are the sources this is where the electrograms will be back adopted and I will take a lot of blame on myself that we turn signals into colors but those colors are doing all the anatomical ablations today but there are several here at this table that are in fact you know showing that that's not only possible but we demonstrated good benefit already and I think so we're heading in a very nice direction there I think yeah and I think you know to get to your you know how do you get through some of the heterogeneity that you that you mentioned Paul the I think one of the ways you do that is you keep the keep our physicians engaged the whole time so when you're making an AI algorithm it's important to have physicians involved not just in the beginning at the you know the when you train the set but as you retrain and as you continue to improve the data set is continuing to have the your clinician partners be your shepherds and also continuing to broaden out the physicians that you have because you know to to Shlomo's point you know garbage in garbage out can can be true but the more people that you have helping to contribute to that you are tapping into a you know all of their knowledge so that way the systems that we are developing eventually in a perfect world will have you know a million ablations worth of experience collectively that's a very nice vision and I think as we're wrapping up I think then I'd like to try to bring all of these points that we've been talking about back to this again this this this main theme of the EP lab of the future so we're collecting all this data and that's gonna eventually I think that would be an amazing I think accomplishment in our field if we can do that but then obviously that's just a means to an end the end is is this EP lab of the future with whatever you want to call it better outcomes for the patients a better workflow a better experience for even the physicians etc maybe cost savings so how do we how do we mean one last comment from everybody what is the what are the what is the priority in each of your minds for the next important step to get us in that direction I think we're we're probably all gonna share the thoughts that have driven us to do the things that we're doing right now so in my opinion the the immediate need that is going to continue to motivate people to collect this data is turn that into something useful and in oftentimes people ask us the question of okay AR it's cool I see a hologram what's the point and and what we're seeing is when you turn data into something contextual and a physician can actually control for the first time they gain significant benefits immediately now that motivates people to collect more data that actually want to see more data in a contextual manner without having to invest in a whole new monitor a whole new connection a whole new facilities bill that they're gonna have to go fight for so I feel like turning the data into something that a physician can touch and feel essentially in an intuitive way in a low resource setting without having to require more and more investment into a facilities in an infrastructure forward integrated if you will to me that's the priority which will motivate everyone to collect all the data that's required and unlock this value that's sitting there in millions of ablations so Paul you know referring to the principles that you mentioned in J&J MedTech we basically talk about four R&D pillars that we have so one is answer where to ablate deliver a better lesion simplify the procedure and minimize or zero so I would not prioritize one over the other but what we should consider is what would bring like the highest impact and there we should you know look at diseases and you know for example we can talk about a feed we know that there is a huge population that suffering from a feed so bringing a good solution under any of those pillars to a feed would make a very large impact in my very unbiased opinion the most dramatic thing that has played out in the operating room environment over the last 10 to 20 years has been the rise of the da Vinci robot and all the orthopedic robots that has transformed medicine in a dramatic fashion EP and the whole cath lab space is 10 to 20 years behind there's very very little robots in it still and I think that as you bring robotics in and that serves as again this kind of digital center this digital hub where all of the procedural information is aggregated for the physician is kind of presented in the right way to the physician that's the most dramatic thing and it can happen today we're starting it today and I I want to add to it because robotic is not the ultimate answer but there is something that you kind of eluded about that in 10 years from now there's not going to be a fib and VT I want to bring one single point this is kind of a fight against a fib or a war against a fib but the number of soldiers is very limited so I'll quote from a PFA symposium that one American physician said great it's a shorter procedure I can do 10 patient a day and then the European physician said what I'll do three cases a day and I get home at 330 in the afternoon so that's a matter of perspective I think from our perspective we have we are both working to make procedures simpler improve outcomes I still think there is a need to improve outcomes I think it's very difficult we are driven by using some of the basic in EP something as basic as the unipolar electrogram how can that make a difference and the tissue response in PFA for example we think there is a path to better outcomes and that is what drives us is by male engineers enabling physicians to treat patients better but I think some other topics like selecting the right patients will be another important trend I don't think we can cure all a fib I think we need to select some but I echo what everyone else has said so I'm just trying to add a bit yeah I think you know overall patient outcomes is is the key and you know that's what's going to resonate with the payers that's what's going to resonate with the hospitals to a degree and it ultimately is you know what I think everybody here has an objective of trying to improve patient outcomes and in the long in the long term and in the in the grandest sense and I think the it's really trying to work in how we can collaborate as a team between clinicians between industry between the payers to try and say you know I think there exists a very adversarial relationship in a lot of ways right now between all three of those bodies and even some of the other bodies and if you want to include regulatory agencies and things like that as well and how do we collaborate so that way we can say we all have the same end goal in mind but how do we move forward together yeah just just one quick note I completely agree with everything that's been said I think from my perspective my goals are to create technology that works the way the physician is visiting it envisioning it to work every time you place the catheter where you want to ablate you make the lesion and it's the lesion that you want and it sounds very simple but that's not what's been happening I think we're getting closer to that but having tools that do what's intended every time can really simplify the things that we've been doing and things we want to do thank you everybody and maybe just to sum up or wrap up I think I like the idea that I think Shlomo mentioned that the future is actually now in the EP lab there will be obviously big changes the years to come but we are doing a lot of things now that we are just innovating already in the lab perhaps you know PFA dual energy with an AR glasses on using big data from a Cardo net with a robotic assist with a mapping system and a complex electrogram analysis and all at the same time maybe so until the robots get sentient that we're still doing what we're doing but thank you everybody for a great session I really enjoyed it

Electrophysiology Lab

artificial intelligence

robotics

data integration

Pulse Field Ablation

patient outcomes

open APIs

clinical adoption