By Lars Thording

The annual Heart Rhythm Society (HRS) Conference in Boston last month displayed the usual wealth of innovation in exhibits from the dominant manufacturers in the electrophysiology space — Biosense Webster, Abbott, Medtronic, Boston Scientific, and Philips. In smaller exhibits, entrepreneurs exhibited novel services and products to improve the performance of electrophysiologists and labs treating patients with arrhythmias.

Upon entrance, the first things to meet your eye were the light displays of the FARAPULSE Pulsed Field Ablation (PFA) system from Boston Scientific and the PulseSelect PFA system from Medtronic. Pulsed-field ablation definitely dominated the talks and the exhibits at the conference. As an alternative to thermal ablation, PFA electronically attacks the cells responsible for the arrhythmia (atrial fibrillation), resulting in a shorter and safer procedure.

PFA is a relatively new technology in atrial fibrillation treatment, but one that has seen surprisingly fast interest and adoption from electrophysiologists. Virtually all the large manufacturers have launched studies aimed at getting clearances to sell their PFA technologies, and the scientific sessions at HRS 2024 were focused on this. Specifically, Biosense Webster presented results of a PFA study, and Boston Scientific had several studies showing strong efficacy and procedural effectiveness of its PFA solution.

Boston Scientific, in general, is making some moves in this part of the cardiology space. While the company’s RHYTHMIA HDx mapping system is recognized as a very strong mapping system, market share has been sluggish, with Boston Scientific owning a distant third place in the market. However, the company’s 2022 acquisition of Baylis Medical — a company offering advanced transseptal access solutions as well as guidewires, sheaths, and dilators used to support catheter-based left-heart procedures — increased its market footprint, and the company has come to dominate the introduction of PFA with its FARAPULSE system. It will be interesting to see if Boston Scientific will eventually threaten the dominance of Biosense Webster and Abbot in electrophysiology technology.

Balancing innovation, costs, and sustainability
HRS has always been focused on innovative technology. In a space where the number of diagnoses grows significantly every year (by 2050, up to 16 million Americans are projected to have atrial fibrillation), manufacturers are investing heavily in new technology that can drive market share and secure solid revenue growth. Devices used in atrial fibrillation ablation procedures are very expensive, and individual (single-use) ablation catheters can cost $4,500 or more. When new technologies are launched, they are typically more expensive than the technologies they replace, and PFA is no exception.

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