HRS 2021 – Who Sets the Agenda in Electrophysiology?

Heart Rhythm Society’s Scientific Sessions 2021 were held on July 28-31 in the Boston Convention and Exhibition Center in Seaport, surrounded by high-end hotels and restaurants,. This annual conference gathers Electrophysiology doctors, scientists, administrators, and technologists who discover, discuss and display new technologies, methodologies and clinical approaches in electrophysiology. This year, the in-person conference was preceded by a virtual experience in late June. As expected, the virtual conference was not even a near-replacement for in-person interaction on the conference floor, where the accidental meetings and the gathering of industry partners lead to lively and educational situations.

Innovative Health was, as usual, present with our single-use device reprocessing exhibit, where we discussed microlumen inspection (our engineers lifted the curtain to our patented technology), EP cable reprocessing, our pending clearances of the Boston Scientific Orion mapping catheter and the Biosense Webster Vizigo steerable sheath, and reprocessing as the only proven, viable circular economy solution in electrophysiology (EP). If we want the EP lab to be more environmentally sustainable, reprocessing is the model to follow.

As usual, the large manufacturers – Biosense Webster, Abbott, Boston Scientific and Medtronic – dominated with their large footprints on the exhibit floor. While most were subdued in their presence and really didn’t offer any big “news” (reveals of new products usually carry the conference, but this year, there were few), Biosense Webster’s presence was notable with an imposing two-story structure, filled to the brim with abundant staff that had very little to do other than look important and chat with each other. Hence, Biosense Webster’s dominance in the market was clearly reflected on the exhibit floor, just like their ability to control utilization decisions down to the lab, and physician level was reflected in the only large product reveal of the conference, the Octaray mapping catheter, which was visually overpowering any other technology message on stairs, banners, outdoor signs, etc.


Reveals of new products usually carry the conference, but this year, there were few.


It has always been difficult for smaller companies in Electrophysiology to gain market access, due to the relationship between the large manufacturers and the physician, due to the unrestricted embeddedness of manufacturer staff in the lab, and due to restrictive contracting. This is a shame, since technology development in Electrophysiology (like most other areas) is often driven by smaller, more entrepreneurial companies. This is usually solved by the large manufacturers gobbling up the smaller innovators, but at this year’s conference, there were very few smaller companies, possibly due to economic and access constraints associated with the pandemic.  

Acutus was a noteworthy exception. While the company emerged on main stage only a few years ago, its revolutionary mapping technology, its refreshing view on the financial impact of new technology adoption, and its bold demeanor has made it the key challenger to the oligopoly of the industry. Other newer companies, such as Galaxy, were promoting and educating about new solutions to Atrial Fibrillation (pulsed field ablation is a completely new modality in Atrial Fibrillation, and Galaxy has successfully positioned itself as a leader in this space).

However, the big picture remains unchanged: Large industry dominates the conference – and large industry owns the discourse about electrophysiology procedures. This may seem surprising, as most of us expect clinicians and lab managers to set the agenda for what technologies are used, what modalities are introduced, and what devices are preferred. After all, clinicians and lab managers are the users, the industry merely the suppliers of products and technologies that the former deem to be desirable. Again, the HRS conference perfectly illustrated that market relations in electrophysiology are not what we would expect.


...the HRS conference perfectly illustrated that market relations in electrophysiology are not what we would expect.


In electrophysiology, the cost of devices and the extensive time involved in procedures are the key barriers to growth and profitability. Therefore, a common goal should be to reduce device costs and procedure time. This would allow electrophysiology labs to offer their services to more patients and to build stronger procedure competency due to increased practice. However, the word “costs” is not spoken at HRS, and when so, not by the manufacturers who define the industry. While HRS is designed to excite physicians with new technologies that reflect their ambitions about clinical excellence, what the industry really needs is a dose of economic reality and a discussion about how we treat more patients for less money. Each and every new technology offered at HRS COSTS MORE, and EP labs cannot continue to absorb this added cost without a shift of discourse that allows EP lab managers and supply chain leaders at the hospital to balance the value of new shiny objects against the fiscal realities of the service line – and drive the discussion about new technology adoption.


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