Everyone at HRS 2024.

Electrophysiology

Cardiac Wire’s Top Six Takeaways from HRS 2024

It might have been graduation time in many parts of Boston last weekend, but an electrophysiology family reunion was taking place in the city’s Seaport district, bringing the latest in EP science, technology, and patient care. We hope everyone who attended HRS 2024 had a blast, and we hope all of you enjoy these top-six takeaways from electrophysiology’s biggest weekend of the year.

• HRS on The Rise – The HRS annual meeting continued its post-COVID rebound, as HRS 2024 welcomed 9,588 attendees as of Saturday afternoon (up from 8,685 last year), and the conference’s exhibits and presentation halls were packed and passionate.

• All About PFA – Pulsed field ablation dominated HRS 2024’s conversations, exhibit booths, and scientific sessions, suggesting that if PFA truly delivers on potential we could be entering electrophysiology’s pulsed field ablation era.

• EP Science – While other cardiology subspecialties have historically been better known for their scientific rigor, there was some serious EP science taking place at HRS 2024, including a number of studies that could shape how electrophysiology is performed for years to come.

• PFA Results – Speaking of PFA and EP science, five of HRS’ late breaker presentations focused on pulsed field ablation, with the studies strongly supporting PFA’s efficiency value proposition, while often showing solid efficacy and safety results.

• AI Momentum – AI was everywhere at HRS, with new solutions supporting a wide range of use cases (detection, prediction, planning, mapping, etc.), and leveraging data from nearly as broad of a range of modalities (ECG, imaging, implants, catheter.). This AI influx also suggests that electrophysiology might have to similarly evolve its AI infrastructure (standards, guidelines, overall expertise.

• RPM Frustration – Although RPM is evolving fast and is more vital than ever, a keen ear could pick up signs of frustration among RPM vendors, including concerns over lagging reimbursements, the need for updated guidelines, and perceptions that all remote monitoring tech is the same (because it’s not).

Bringing AI Into Echo Workflows

Cardiovascular AI solutions are still far more commonly found in cardiology journal papers than in actual clinical workflows, but that’s changing fast and there’s a lot to learn from AI early adopters. Tune into the latest Cardiac Wire Show with Mount Sinai’s Jeffrey Bander, MD and Us2.ai’s Seth Koeppel to see how they launched and expanded their echo AI partnership, and learn how to “adopt echo AI the right way.”

Cleerly Transforming Cardiovascular Event Prevention

There’s been plenty of studies evaluating healthcare AI accuracy, but does AI improve patient care? Check out this Cardiac Wire show with Udo Hoffmann, MD, MPH and learn how Cleerly’s new TRANSFORM trial could prove that AI-guided cardiovascular care reduces heart attacks.

The Wire

• Cape Cod Hospital’s Massive TAVR Fine: Cape Cod Hospital will pay a whopping $24.3M to resolve allegations that it knowingly billed Medicare for pre-TAVR evaluations that didn’t meet requirements. Between 2015 and 2022, the hospital submitted millions of dollars in TAVR-related False Claims, including claims for evaluations that didn’t involve enough physicians, and cases where evaluations weren’t documented or shared with the TAVR team. The fine comes after “years of internal warnings” and stems from a whistleblower lawsuit from the former leader of the hospital’s TAVR program.

• Medtronic’s PFA Evidence: The SPHERE Per-AF trial randomized 420 patients with persistent AFib to undergo PFA with Medtronic’s Affera System and its Sphere-9 dual-energy catheter, or to undergo RF ablation. After one year, PFA patients achieved greater freedom from AFib (73.8% vs. 65.8%) and similarly low rates of primary safety events (1.4% vs. 1.0%). PFA was also more efficient in terms of total energy application time (7.1 vs. 36.4 min), ablation time (46.7 vs. 73.5 min), and skin-to-skin time (100.9 vs. 126.1 min).

• Tuning CMRI for Female HFpEF: UK researchers fine-tuned cardiac MRI scanning protocols to make them more sensitive for detecting HFpEF in women, who are disproportionately affected by the HF type. Researchers tested the CMRI technique for measuring pulmonary capillary wedge pressure in 454 patients, finding that their sex-specific PCWP protocol was better at predicting heart failure hospitalization (HR=3.9) and MACE (HR=2.4) than generic cardiac MRI protocols that didn’t take gender into account.

• Implicity’s SignalHF Cleared: Implicity expanded to heart failure with the FDA clearance of its SignalHF algorithm, which analyzes data from remote cardiac monitoring devices to identify patients who are at high risk of experiencing worsening heart failure. SignalHF’s machine learning algorithm was trained on the massive Health Data Hub database to spot patients who are at risk of future heart failure events based on their implant data (ICDs, pacemakers, CRT-Ps, CRT-Ds), including implants from all major brands.

• Biosense Webster’s VARIPULSE Data: One year results from Biosense Webster’s admIRE trial suggest that the VARIPULSE PFA platform is effective, efficient, safe, and often zero-fluoro. Among 277 participants with paroxysmal AFib treated with VARIPULSE, 75% had no  atrial arrhythmia recurrence at one year (85% w/ 73-96 PFA applications), with a 2.9% primary adverse event rate and no procedure or device-related primary adverse events. The procedures were performed in an average of 80 minutes, with a 7 minute average fluoroscopy time, and 25% of procedures performed without fluoroscopy.

• Comparing Diuretics: The DEA-HF study found that combining the IV loop diuretic furosemide with the oral quinazoline metolazone was the most effective regimen for patients with congestion-refractory HF, but not the safest. In 42 patients, the volume of sodium excreted was highest for furosemide/metolazone (4,691 mg), followed by furosemide alone (3,835 mg) and furosemide with acetazolamide (3,584 mg). However, incidence of worsening renal function was far higher with furosemide/metolazone (41%), versus furosemide alone (17%) and furosemide/acetazolamide (2.6%). 

• Story Health & Saint Luke’s AFib Program: Story Health and the Saint Luke’s Mid America Heart Institute launched a new AFib partnership, integrating Saint Luke’s expert clinicians with Story Health’s virtual care platform and health coaches. The new program leverages Story Health for engaging patients in between clinic visits, including symptom management, ECG monitoring, treatment optimization, and continuous patient support. Story Health previously focused on heart failure care, and the Saint Luke’s partnership begins the rollout of its new AFib program.

• Modular S-ICD + Leadless Pacing: Boston Scientific’s modular Cardiac Rhythm Management system (mCRM) shined at HRS, where the MODULAR ATP study showed that the combination of BSCI’s Empower leadless pacemaker with its Emblem subcutaneous implanted defibrillator is safe and effective – while avoiding the risk of leads. Among 151 patients, the mCRM beat its six month goals for freedom of leadless pacemaker–related major complications (97.5% vs. 86%), device-to-device communication (98.8% vs. 88%), and patients with ≤2.0 V pacing thresholds (97.4% vs. 80%), while 61.3% of arrhythmias were terminated by antitachycardia pacing.

• What’s the Value of CV Biomarkers? A multinational primary prevention study of 164k people found that a range of biomarkers (cardiac troponin, natriuretic peptide, high-sensitivity C-reactive protein) were significantly associated with ASCVD (17.2k events over 11.8 years). However, combining these biomarkers with established risk factors only led to modest prediction improvements. For example, combining cardiac troponin and hsCRP to NT-proBNP didn’t improve its predictive value (C-statistic: 0.812 to 0.8194). 

• Atraverse’s Left Access Clearance: Left-heart access startup Atraverse Medical had a big HRS, announcing the FDA clearance of its flagship HOTWIRE RF guidewire and the completion of a $12.5M Seed round. The HOTWIRE RF guidewire enables zero exchange left-heart access, while also acting as a rail for catheter-based therapy systems. Atraverse launches with solid EP credibility given that it was founded by Farapulse co-founders Dr. Steven Mickelsen and John Slump.

• SAVR’s Bicuspid AS Advantage: The NOTION-2 study suggests that SAVR and TAVR have largely similar outcomes among younger and lower-risk AS patients, while patients with bicuspid aortic stenosis are better off getting surgery. In 370 patients under age 75, the rates of primary endpoint events (all-cause mortality, stroke, or rehospitalization) at one year were far higher for TAVR patients in the bicuspid AS group (14.3% vs. 3.9% surgery), but they were similar in the tricuspid AS group (8.7% vs. 8.3% surgery).

PIA’s Post-Processing Solution

Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency.

TeraRecon’s Structural Heart Enhancements

Detecting and addressing mitral valve and LAA conditions can be challenging. Check out TeraRecon’s Structural Heart white paper and discover how improving workflow and pretreatment planning can streamline these processes and potentially improve patient outcomes.

The Resource Wire

• FFRCT Slashes PAD + CAD Mortality: See how adding HeartFlow’s FFRCT assessments to patient workups prior to peripheral artery disease surgeries can have a massive impact on coronary artery disease outcomes, including major reductions in long term heart attack and mortality risks.

• Nothing Is More Expensive Than a Missed Opportunity: The emergence of AI CAC detection and new CVD treatments could transform preventative CVD care. Check out this Johns Hopkins editorial in JACC detailing how solutions like Bunkerhill Health’s Incidental CAC algorithm can create opportunities for more effective preventative CVD care, but only if providers seize that opportunity.

• Monebo’s AF ECG Algorithm: Atrial fibrillation is often difficult to characterize with an automated algorithm due to the changing waveform morphology, system, or muscle noise. This is especially true given the size constraints of ambulatory devices to detect AFib. See how Monebo’s Kinetic AF ECG Algorithm overcomes these size limitations without sacrificing accuracy.

• Experience the future of learning: Medtronic Academy 2.0 is here! Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

• Streamlining Cath Lab Hemodynamic Workflows: Is your hemodynamic solution keeping your cath lab efficient? Merge Hemo is a cath lab hemodynamic monitoring solution, providing a Best in KLAS user experience, while enhancing clinical workflows, automating data collection, and streamlining inventory management.