Electrophysiology (EP), as a subspecialty, is coming into its own. Electrophysiologists have access to more capital than in the past, and with a 10 to 15 percent annual market growth, it is one of the fastest growing sectors within cardiology. Vendors have taken notice and are focusing on technology and designs that cater specifically to EP docs.
Historically, in hospitals, cardiac surgery and interventional cardiology have driven financial growth. Today, however, cardiac surgery and cath lab volumes are down, as are their margins, while EP volume and its margins are up, says Laurence Epstein, director of electrophysiology at Brigham and Women’s Hospital (BWH) in Boston.
Driving from the cockpit
While EP is growing in stature, the labs are often crowded and cluttered with tangles of equipment and cables. Long, complex procedures are made more tedious by repositioning equipment, walking back and forth to the control room and working with dissimilar systems. The “EP Cockpit” from Philips Healthcare organizes the tangled mess of equipment into to one movable ceiling mount. The equipment is accessed from a tableside control panel. Cost is about $300,000.
The cockpit’s 56-inch, high-resolution monitor displays up to 16 inputs, including live and reference x-rays, hemodynamic data, intracardiac ultrasound (ICE), 3D mapping and video switching—which eliminates the need for half a dozen or more smaller monitors dotted throughout the lab. Physicians can preset the tableside interface to highlight any one of the inputs, such as ICE or 3D mapping, during the procedure.
At the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, in Austin, Texas, the cockpit allows for “a more rational placement of all the tools, a way to have a more functional lab with less chance of noise during the procedure,” says Andrea Natale, MD, executive medical director.
At BWH, the EP lab has a 56-inch screen from Carrot Medical, with similar “cockpit” capabilities. This model costs between $150,000 to $200,000, which can include an integrated wireless intercom system and the ability to record imaging in real time. Advances in the pipeline from Carrot, however, include gesture technology, which would allow physicians to manipulate images on the screen without touching it, like operating a Nintendo Wii. Physicians also will be able to “draw” on the screen without touching it. “If I need to measure a beat on the electrical signals and I point it out to someone, invariably that person never puts their cursor on the right beat. With this advanced technology, I’ll be able to circle the area with my fingers without touching the screen,” says Epstein.
The EP Cockpit is the final piece that integrates all the technologies and allows easy access from one keyboard panel for Tom Lonergan, executive director of the Hoag Heart and Vascular Institute at Hoag Memorial Hospital Presbyterian, Newport Beach, Calif. “That is where the edge of the universe is for EP right now,” he says. “You want to have the right tools, but you want them all integrated into a seamless system that makes it operationally efficient from a business standpoint, reduces procedure time, lowers costs and improves outcome.”
Balloons, robots & 3D imaging
Having technology like the cockpit helps electrophysiologists, especially during long, complex ablations for atrial fibrillation (AF) and ventricular tachycardia (VT). Advances in ablation technology such as 3D mapping and remote robotic catheter navigation have enabled the growth of radiofrequency ablation (RF) procedures for AF and VT. But even RF ablation is challenging, says Epstein, which is why research is ongoing into other ablative therapies, such as cryo-balloons, laser balloons and high-intensity focused ultrasound balloons. “In about a decade, we might even be able to deliver focused ultrasound energy from outside the heart,” says Epstein.
The use of remote robotic navigation is gaining momentum for several reasons: it delivers better precision than manual navigation, allows physicians to place mapping catheters in hard-to-reach anatomical locations within the heart with stability, and spares the operator radiation exposure during long procedures. Two robotic systems are available: Stereotaxis Magnetic Navigation System and Hansen Medical Sensei Robotic Catheter System. Stereotaxis costs about twice as much as Hansen and has considerable siting requirements—but it has been around longer, which has created a certain comfort