Latest / Vanguards of Healthcare by Bloomberg Intelligence / Vektor Medical Applies AI to ECGs to Expand Arrhythmia Treatment Pathway

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Vektor Medical Applies AI to ECGs to Expand Arrhythmia Treatment Pathway · Vanguards of Healthcare by Bloomberg Intelligence

• 0:18
  Speaker 1: Welcome to another exciting episode of the Vanguards of Healthcare series.
• 0:22
  Speaker 1: My name is Matt Hendrickson, the medical technology analyst at
• 0:24
  Speaker 1: Bloomberg Intelligence, which is the in house equity research platform
• 0:28
  Speaker 1: of Bloomberg ELP. We're pleased to have with us today
• 0:31
  Speaker 1: Rob Cruman, CEO of Vector Medical. Vector Medical is a
• 0:35
  Speaker 1: medical device company that is driving the development of non
• 0:38
  Speaker 1: invasive ECG or electrocardiogram mapping with its VMAP system utilizing AI. Rob,
• 0:46
  Speaker 1: thanks for joining us.
• 0:47
  Speaker 2: Matt, delighted to be here, Thanks so much for having
• 0:49
  Speaker 2: me again, and really excited to talk about what we've
• 0:52
  Speaker 2: been doing over the last few years at Vector Medical.
• 0:55
  Speaker 1: Absolutely. I mean, it's been a couple of years since
• 0:57
  Speaker 1: you joined us. A lot of new developments have happened
• 1:00
  Speaker 1: since then. But why don't we ground the listeners with
• 1:04
  Speaker 1: exactly what Vector Medical and what vmap is designed to do.
• 1:09
  Speaker 2: Yeah, delighted to talk to you about that, Matt. So
• 1:11
  Speaker 2: our company was founded with the idea of improving a
• 1:15
  Speaker 2: rhythm of medicine, and just really quickly a rhythm of medicine.
• 1:18
  Speaker 2: We're looking at abnormal rhythms in the heart hroal fibrillationventricular tachycardia,
• 1:23
  Speaker 2: other problems of heartbeats that are either too fast, too slow,
• 1:27
  Speaker 2: or regular. And what we did about a decade ago
• 1:30
  Speaker 2: is we started using AI to enhance algorithms and software
• 1:34
  Speaker 2: to better be able to understand the data that's in
• 1:37
  Speaker 2: each patient's ECG. And our goal with that was to
• 1:41
  Speaker 2: bring forward personalized medicine and rhythmic therapy and improve patient outcomes.
• 1:46
  Speaker 1: Okay, and so let's take a step. As I'm a patient,
• 1:52
  Speaker 1: I'm having heart issues. I suspected maybe a FAB I
• 1:58
  Speaker 1: read it online. I go the doctor, the doctor, I
• 2:00
  Speaker 1: go lend. The doctor gets me to the cardiologists. What
• 2:03
  Speaker 1: is the cardiologist doing to before and after using VMAP
• 2:10
  Speaker 1: and basically when does when do they start using VMAP
• 2:13
  Speaker 1: as a tool.
• 2:15
  Speaker 2: So in your journey, and this happens for millions of
• 2:18
  Speaker 2: patients around the world, you're going to get diagnosed with
• 2:21
  Speaker 2: your arrhythmia, whether that's let's say it's atrial fibrillation in
• 2:23
  Speaker 2: your case and you're experiencing symptoms, You're going to go
• 2:26
  Speaker 2: to a specialized cardiologist called an electrophysiologist. And that person
• 2:30
  Speaker 2: has spent about as much time as you can in
• 2:34
  Speaker 2: residency and other fellowships in order to become super specialized
• 2:37
  Speaker 2: in this area. And what they're going to do is
• 2:39
  Speaker 2: they're going to start to think about your treatment pathway.
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  Speaker 2: Often that starts with anti rhythmic drugs, but that's only
• 2:46
  Speaker 2: a short term solution, and so then we start thinking
• 2:48
  Speaker 2: about a blate of therapies, which simply means taking some
• 2:52
  Speaker 2: sort of a heat or a cold mechanism or an
• 2:54
  Speaker 2: energy source into your heart and treating the cells that
• 2:57
  Speaker 2: are causing your rhythmia. And what we do with VMAP,
• 3:01
  Speaker 2: that's our technology in vectro medical is we again were
• 3:04
  Speaker 2: able to analyze the ECG to be able to tell
• 3:07
  Speaker 2: the doctor a little bit more information about where you
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  Speaker 2: rhythmia is caused. And when we know that, then we
• 3:13
  Speaker 2: can take those a blatee of therapies in your heart,
• 3:16
  Speaker 2: treat those cells that are causing rhythmia, and amazingly, the
• 3:20
  Speaker 2: incredible thing about your body is it returns to normal
• 3:23
  Speaker 2: rhythm if we can get rid of those diseased or
• 3:26
  Speaker 2: damaged heart cells.
• 3:28
  Speaker 1: Okay, I see that now, and so yeah, one of
• 3:31
  Speaker 1: the steps to getting VMAP commercialized was the VMAP study
• 3:37
  Speaker 1: and so what was the key takeaways from that? Those
• 3:42
  Speaker 1: study results that kind of said, aha, this is replacing
• 3:45
  Speaker 1: kind of the standard of care. And I'll just add
• 3:48
  Speaker 1: in there as well, like because it was a comparison study,
• 3:54
  Speaker 1: what was the comparison or what was the comparator that
• 3:58
  Speaker 1: VMAP was kind of being utilized with.
• 4:01
  Speaker 2: The VMAP study is an incredibly exciting study. So this
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  Speaker 2: study was conducted in twenty twenty two or twenty twenty
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  Speaker 2: one and then was published back in twenty twenty two.
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  Speaker 3: And what it looked.
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  Speaker 2: At is two hundred and fifty five separate arrhythma episodes
• 4:16
  Speaker 2: in two hundred and twenty five patients and incredible study,
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  Speaker 2: gold standard, blinded, multi center, independently adjudicated study. And there
• 4:25
  Speaker 2: were two separate arms. One arm of the study took
• 4:28
  Speaker 2: the patients themselves and looked at and this is what
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  Speaker 2: the comparator was.
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  Speaker 3: Where did the arrhythmia terminate?
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  Speaker 2: Where did we apply energy and we effectively healed the patient.
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  Speaker 2: So the only cases that were in the study were
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  Speaker 2: success story cases. On the other side of the study
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  Speaker 2: was a blinded set of electrophysiologists who took just the
• 4:50
  Speaker 2: patient's patient's ECG and ran it through our system, the
• 4:53
  Speaker 2: VMAP system, and came up with those areas of interest,
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  Speaker 2: where should we be, where should we have done hbilation,
• 5:00
  Speaker 2: and then we match those and the incredible part was
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  Speaker 2: we saw outstanding accuracy, over ninety percent accuracy across this
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  Speaker 2: this two hundred and fifty five ridden the episodes. And
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  Speaker 2: so what we showed is that VMAP is incredibly accurate
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  Speaker 2: and it also showed that the ability to analyze the
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  Speaker 2: ECG is incredibly fast. So when we run a patient
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  Speaker 2: through VMAP, it takes forty eight seconds, which is incredibly
• 5:25
  Speaker 2: important for workflow issues in a modern electrophysiology lab.
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  Speaker 1: Yeah, and so I mean that kind of goes back
• 5:31
  Speaker 1: to you know, it's such a quick tool, an efficient tool.
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  Speaker 1: Let's say that it just it's you know when link
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  Speaker 1: get is this something where that it takes an extra
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  Speaker 1: patient visit, because that's the thing. You don't you don't
• 5:47
  Speaker 1: have a patient to come in just for a forty
• 5:48
  Speaker 1: eight second review of the ECG monitors. So how is
• 5:54
  Speaker 1: it they have the ECG and then this is this
• 5:56
  Speaker 1: the VMAP is being utilized the same day before the
• 6:00
  Speaker 1: procedure starts, or is this something where the doctor is
• 6:03
  Speaker 1: utilizing this in between to kind of then understand exactly
• 6:07
  Speaker 1: the mapping the path it wants to go to before
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  Speaker 1: it gets into the procedure.
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  Speaker 2: So, Matt, the exciting thing is the answer to that
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  Speaker 2: is yes to both. So, because the ECG is the
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  Speaker 2: only thing that VMAP needs to be able to understand
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  Speaker 2: your rhythma better, we can map you during a procedure,
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  Speaker 2: which is often the case the doctor needs to know
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  Speaker 2: additional information about how to treat you, or maybe you
• 6:28
  Speaker 2: have multiple arrhythmias, and therefore providing the quick guidance information
• 6:33
  Speaker 2: during the procedure is vital. On the other hand, because
• 6:37
  Speaker 2: the ECG is the most commonly used testing cardiology, we
• 6:41
  Speaker 2: can take your ECGs from last week, last month, and
• 6:45
  Speaker 2: we can run it through the system. And so often
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  Speaker 2: what we're asked by doctors to do is be a
• 6:50
  Speaker 2: part of the clinic, the arrhythmia clinic. A patient will
• 6:52
  Speaker 2: come in when their rhythmia, they're not feeling well. The
• 6:56
  Speaker 2: doctor typically takes their ECG and then does a manual
• 6:59
  Speaker 2: or or person based review, a human based review of
• 7:05
  Speaker 2: the ECG, and that only gives you so much information.
• 7:08
  Speaker 2: But then we can run it through VMAP and we
• 7:11
  Speaker 2: can give you incredible insights about how complex rhythm is,
• 7:15
  Speaker 2: what kind of tools we would want to use during
• 7:17
  Speaker 2: that during that treatment, and also whether we can whether
• 7:21
  Speaker 2: we can do you locally. Let's say you live in
• 7:23
  Speaker 2: a rural area and you just want to go to
• 7:25
  Speaker 2: your doctor, your electro physiologists, Well, if we give them
• 7:28
  Speaker 2: the insights that allows the doctor there and your regional
• 7:32
  Speaker 2: hospitalill be able to treat you rather than for you
• 7:34
  Speaker 2: to have to go into you know, maybe an academic
• 7:36
  Speaker 2: institution that's several you know, several hundred miles away.
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  Speaker 1: And that's always interesting too, because the thing that I'm
• 7:42
  Speaker 1: seeing with AI, especially in medtech, is that you're able
• 7:45
  Speaker 1: to aggregate data from all over the country and be
• 7:50
  Speaker 1: able to use it as a comparator for that one patient,
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  Speaker 1: whereas you're talking about that rural patient, you know, and
• 7:57
  Speaker 1: EP even if there are specialized EPs in or Texas,
• 8:00
  Speaker 1: let's say they're not going to have hundreds and hundreds
• 8:04
  Speaker 1: of patients, they're going to have a dozen patients, twenty patients.
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  Speaker 1: And having those ten to twenty kind of patient, you know,
• 8:13
  Speaker 1: as like as being a comparator, that's far less than
• 8:17
  Speaker 1: I'm assuming millions of different cases that you have within
• 8:21
  Speaker 1: the vmap AI system.
• 8:22
  Speaker 2: Right, Well, that's exactly right. We see VMAP as a
• 8:25
  Speaker 2: tool for democratizing electrophysiology. You know, whether you're you know,
• 8:30
  Speaker 2: the tip top institutions around the country and you're treating
• 8:33
  Speaker 2: you know, hundreds of patients a year, or whether you're
• 8:36
  Speaker 2: at a hospital that's just dealing with their local clientele
• 8:39
  Speaker 2: and maybe you have other responsibilities as well. We see
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  Speaker 2: the technology is really being able to raise the floor
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  Speaker 2: in rhythma understanding. And I do think that we do
• 8:48
  Speaker 2: better medicine when we're able to keep treatment at the
• 8:52
  Speaker 2: local level, because one of the big problems with arrhythmia
• 8:55
  Speaker 2: medicine is patients don't seek the treatment.
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  Speaker 3: We now know.
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  Speaker 2: It's been published both in the US and Europe that
• 9:00
  Speaker 2: getting an ablation is much better than anti rhythmic drugs
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  Speaker 2: or no therapy whatsoever. It's been shown that you should
• 9:07
  Speaker 2: get an ablation, you should get it as early as
• 9:09
  Speaker 2: you can, because the outcomes are better earlier. But patients
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  Speaker 2: don't because they're scared, because they don't have enough information,
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  Speaker 2: and maybe because they're too far away from the right
• 9:19
  Speaker 2: sort of hospital environment. And if we can have them
• 9:22
  Speaker 2: treated there at their local hospital, blind they're local electrophysiologists.
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  Speaker 2: I do think we make real impacts in a course
• 9:29
  Speaker 2: of what is truly a global medical issue. Then we
• 9:34
  Speaker 2: have to tackle, yeah, especially with our arrest eMates.
• 9:37
  Speaker 1: We have, like we're seeing over thirty five million patients
• 9:39
  Speaker 1: in the US with atual fibrillation, and it's very under penetrated,
• 9:44
  Speaker 1: especially once you heart games with the persist and in
• 9:46
  Speaker 1: the permanent AF definitely seems like an opportunity to kind
• 9:50
  Speaker 1: of expand those horizons there for physicians that are not
• 9:53
  Speaker 1: in the big cities.
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  Speaker 2: You know, the numbers are really staggering because you're talking
• 9:57
  Speaker 2: about those that have been officially diagnosed, but we know
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  Speaker 2: there are millions who don't get diagnosed. Now Happily, there's
• 10:03
  Speaker 2: cool technologies like the eyewall, you know, the Apple watch
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  Speaker 2: and other neat wearable that you can get information about
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  Speaker 2: rhythmia that's going to help as well. But our caseload
• 10:13
  Speaker 2: in arrhythmia is staggering, so we have to find ways
• 10:17
  Speaker 2: to get more patients to care and get them through
• 10:19
  Speaker 2: the system quickly so that they can get back to
• 10:21
  Speaker 2: living their normal life.
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  Speaker 1: Fascinating, and then let's kind of just jump back to
• 10:27
  Speaker 1: a little bit of the past. After the VMAP study,
• 10:29
  Speaker 1: you've got FDA approval for the first generation VMAP, and
• 10:34
  Speaker 1: since then it's been kind of expanding. But first off
• 10:38
  Speaker 1: with the VMAP itself, because it's an AI software, how
• 10:43
  Speaker 1: is that being commercialized with the EPs and the hospital setting.
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  Speaker 2: So it's interesting being a company that's been using machine
• 10:53
  Speaker 2: learning and AI techniques for a decade. At the beginning,
• 10:56
  Speaker 2: it was hard to get people to trust a thinking
• 10:59
  Speaker 2: or or learning type computer system right and today now
• 11:02
  Speaker 2: we have claud and we have all the other chat
• 11:06
  Speaker 2: ept that help us better understand how these mechanisms can
• 11:10
  Speaker 2: work and speed up some of our processes. When we
• 11:13
  Speaker 2: went through the FDA, we spent a long time having
• 11:16
  Speaker 2: conversations with them about what we were doing, how we
• 11:19
  Speaker 2: were developing, and that making them really comfortable with the
• 11:21
  Speaker 2: way we develop the technology. So what we do is
• 11:24
  Speaker 2: we use our techniques in the development of the software,
• 11:29
  Speaker 2: and then as it's put into what we call our
• 11:31
  Speaker 2: commercial units, are the ones that sit in the hospital,
• 11:34
  Speaker 2: all of that's locked down, so there is no more
• 11:36
  Speaker 2: development that happens in that box that sits there. It
• 11:39
  Speaker 2: is fundamentally as it is and it does what we
• 11:43
  Speaker 2: expected to do. Every single time. There is no opportunity
• 11:46
  Speaker 2: for hallucinations as you might hear from sort of AI technologies,
• 11:50
  Speaker 2: and we have to be careful of that. But the
• 11:51
  Speaker 2: neat part is we get data every day, every week,
• 11:55
  Speaker 2: every month from our hospitals and the cases that we do,
• 11:58
  Speaker 2: we bring that back and then we develop the next
• 12:01
  Speaker 2: more intelligent version and put that into the software. So
• 12:04
  Speaker 2: we're regularly updating and learning in incremental steps so that
• 12:08
  Speaker 2: patients can feel comfortable that they're being treated appropriately and
• 12:12
  Speaker 2: better every time, but also all of us who care
• 12:15
  Speaker 2: from a safety standpoint and from a regulatory standpoint that
• 12:18
  Speaker 2: we're also meeting the highest possible standards.
• 12:21
  Speaker 1: Okay, I'm going to save one question for the when
• 12:24
  Speaker 1: we talk about some of the recent announcements at the
• 12:26
  Speaker 1: end of last year with the next gen VMAP, mainly
• 12:29
  Speaker 1: about that that locking in and then the upgrades and
• 12:32
  Speaker 1: everything like that because of the you know, when you
• 12:34
  Speaker 1: talk about AI, exactly like you. The thing about AI is,
• 12:38
  Speaker 1: you know, if you can avoid those hallucinations, if you
• 12:41
  Speaker 1: get more and more data, and you should be able
• 12:43
  Speaker 1: to have a better understanding of each individual patient's heart
• 12:48
  Speaker 1: because you know, you just have that larger sample size
• 12:52
  Speaker 1: but let's just also then go with you know, with
• 12:55
  Speaker 1: the VMAP, what is it currently labeled for, because you
• 12:57
  Speaker 1: know we're talking about atrial fibrillation, but there's so many
• 13:00
  Speaker 1: different cardiac arrhythmia cases that can utilize VMAP potentially.
• 13:07
  Speaker 2: Yeah, So clearly the most talked about arrhythmias is atrofibrillation
• 13:11
  Speaker 2: because that's the most most patients have. If they haven't rhythmia,
• 13:15
  Speaker 2: it's often atro fibrillation. But there are there are multitude
• 13:19
  Speaker 2: and and VMAP today is currently cleared for eight different arrhythmias,
• 13:24
  Speaker 2: from matro fibrillation and ventricular fibrillation, some of the most
• 13:27
  Speaker 2: complex to some of the most common, like premature ventricular complexes,
• 13:32
  Speaker 2: to some of them the scary, like ventricular techycardia, which
• 13:35
  Speaker 2: does have a real risk of death and other serious
• 13:40
  Speaker 2: side effects. And so we can treat that whole gambit
• 13:43
  Speaker 2: and provide that information, And you ask what we're what
• 13:45
  Speaker 2: do we what's are labeling? We provide additional information that
• 13:49
  Speaker 2: isn't otherwise available in the EP environment, and we do
• 13:53
  Speaker 2: it rapidly, and we help the doctor better understand that
• 13:56
  Speaker 2: patient and how that patient can better be treated.
• 14:00
  Speaker 1: Interesting and then lastly too just you know, the other
• 14:03
  Speaker 1: thing that's always a big part of the commercial launch
• 14:06
  Speaker 1: is just how the technologies are imbursed for the hospital,
• 14:10
  Speaker 1: And it sounds like there's potentially two different settings. There's
• 14:13
  Speaker 1: the one before the pre planning component where the you know,
• 14:17
  Speaker 1: the initial look at where in the heart you know,
• 14:20
  Speaker 1: the patient can target with the ablation therapy. But there's
• 14:24
  Speaker 1: also then the during the procedure itself, just to kind
• 14:28
  Speaker 1: of as a as an interior procedural check up kind
• 14:30
  Speaker 1: of as you're going through the process. My understanding is
• 14:36
  Speaker 1: just you know, when you're doing the ablation procedure itself,
• 14:39
  Speaker 1: you have a you have a you know, a DRG
• 14:41
  Speaker 1: code that's all encompassing, and then there's also the other skin.
• 14:45
  Speaker 1: Then for other diagnostic procedures you've kind of get those
• 14:48
  Speaker 1: little mini one off kind of diagnostic reimbursements. Is that
• 14:52
  Speaker 1: the way to think about it with VMAP where you
• 14:55
  Speaker 1: kind of get that you know, diagnostic reimbursement pre planning,
• 14:59
  Speaker 1: But if it's the procedure itself, it's part of that
• 15:01
  Speaker 1: over encompassing reimbursement package or is it something different.
• 15:06
  Speaker 2: Well, you've managed to bring reimbursement, which is one of
• 15:09
  Speaker 2: those incredibly complex but super important issues for all medical devices.
• 15:16
  Speaker 2: And one of the things I'm so proud of is
• 15:18
  Speaker 2: that we've worked hand in hand with AMA and CMS
• 15:21
  Speaker 2: to try to get appropriate value for hospitals to use
• 15:25
  Speaker 2: a technology that's helping people. And so a few years
• 15:28
  Speaker 2: ago we were granted a Category three code, a CPT
• 15:33
  Speaker 2: three code, and that code zero eight nine seven T
• 15:38
  Speaker 2: provides currently eight hundred and seventy seven dollars of reimbursement.
• 15:42
  Speaker 2: And then now that's scaled up and down depending where
• 15:45
  Speaker 2: you are, and you know, if you're in a more
• 15:46
  Speaker 2: expensive city, that number goes up a little bit, if
• 15:48
  Speaker 2: you're a less expensive place, that number goes down a
• 15:51
  Speaker 2: little bit. But what that is intended to do is
• 15:54
  Speaker 2: for Medicare to help those patients who are receiving the
• 15:59
  Speaker 2: benefits of this teacher give some money back to the hospital.
• 16:03
  Speaker 2: So we have our customers pay for our technology and
• 16:06
  Speaker 2: then they seek reimbursement and then they're given that amount
• 16:10
  Speaker 2: that we talked about. We're also in this in the
• 16:13
  Speaker 2: process of working towards a Category one code, which would
• 16:17
  Speaker 2: ultimately provide reimbursement for the technology, not just from Medicare patients,
• 16:22
  Speaker 2: but for all of our private payers who are also
• 16:24
  Speaker 2: seeing the benefit. We're engaged with private payers today and
• 16:28
  Speaker 2: so you know, we see this as a real opportunity
• 16:30
  Speaker 2: to again bring forward a technology support its cost. Obviously
• 16:35
  Speaker 2: take some cost or to provide an AI based technology,
• 16:39
  Speaker 2: but because of the value, we've really seen AMA and
• 16:42
  Speaker 2: CMS step up and support what we're doing, which we're
• 16:46
  Speaker 2: we're really happy about. We're also excited that we have
• 16:49
  Speaker 2: that we've had in the past and we have today
• 16:51
  Speaker 2: the support of societies in these efforts. We work hand
• 16:54
  Speaker 2: in hand with, you know, whether it's har Rhythm Society
• 16:57
  Speaker 2: or the AMA, the AHE to make sure that we're
• 17:01
  Speaker 2: representing what helps physicians because they're really the tip of
• 17:05
  Speaker 2: the spear in providing the medicine. And so you know,
• 17:09
  Speaker 2: that's a big conversation that we're having all the time,
• 17:12
  Speaker 2: and we're excited with the support we've had so far.
• 17:15
  Speaker 1: Now, I'm curious about what the transition from the category
• 17:19
  Speaker 1: three day to the category one code has been for you,
• 17:23
  Speaker 1: because there's a lot of variable outcomes in the past.
• 17:28
  Speaker 1: When I'm thinking about some people having category three category one,
• 17:33
  Speaker 1: some has been very seamless, and it's just as if
• 17:35
  Speaker 1: the Category three was a Category one the entire time.
• 17:38
  Speaker 1: Others have had hiccups. I'm curious how you have seen,
• 17:43
  Speaker 1: you know, those historic cases and kind of if there
• 17:47
  Speaker 1: was any learning curves or anything like that that you
• 17:49
  Speaker 1: can be like, okay, don't do that, and okay, let's
• 17:52
  Speaker 1: go this down this path.
• 17:54
  Speaker 3: Well, anything related to reimbursement.
• 17:57
  Speaker 2: I would suggest for any medical device company or any
• 18:00
  Speaker 2: one who's got a technology such as ours, is to
• 18:03
  Speaker 2: work with the people who've done it before. It's its
• 18:05
  Speaker 2: own language. It's literally like speaking a foreign language when
• 18:08
  Speaker 2: trying to understand it, and you need the folks that
• 18:10
  Speaker 2: understand the system. But the truth is is that CMS
• 18:15
  Speaker 2: and the AMA want to support technologies that help people,
• 18:19
  Speaker 2: and so they've established a set of rules, and I
• 18:21
  Speaker 2: can break them down as simple as possible for lay
• 18:24
  Speaker 2: people or people who take it like myself, who take
• 18:27
  Speaker 2: a little bit longer to understand all these things. So
• 18:30
  Speaker 2: a few of the steps are you have to demonstrate
• 18:32
  Speaker 2: widespread usage. So you have to say, we haven't just
• 18:34
  Speaker 2: invented a technology, but we have a technology that doctors
• 18:38
  Speaker 2: are using on their patients, and so.
• 18:42
  Speaker 3: We're happy to say.
• 18:43
  Speaker 2: That, you know, when we started doing this a few
• 18:45
  Speaker 2: years ago we did a few hundred, and then the
• 18:47
  Speaker 2: next year we were great, we're going to do better
• 18:48
  Speaker 2: than that, so we did several hundred. Last year we
• 18:51
  Speaker 2: did nearly two thousand procedures, and this year we're on
• 18:54
  Speaker 2: track to do three thousand procedures, and so we're really
• 18:58
  Speaker 2: excited to show that the the physicians are demonstrating the
• 19:03
  Speaker 2: value of the technology by continuing to use it over
• 19:05
  Speaker 2: and over again for their patients. The next step is
• 19:09
  Speaker 2: potentially the most important, and it's one of my key
• 19:11
  Speaker 2: focuses for our team, and that's developing the clinical evidence
• 19:14
  Speaker 2: that you need. So when you submit for a Category
• 19:17
  Speaker 2: one code you have to have you can submit up
• 19:20
  Speaker 2: to five manuscripts published articles that support the use of
• 19:25
  Speaker 2: your technology, and so we've been really focused on Look,
• 19:30
  Speaker 2: we have over fifty poster presentations, abstracts and manuscripts that
• 19:35
  Speaker 2: we've done over our history. We get to pick our
• 19:37
  Speaker 2: best five, so we put those in front of we
• 19:40
  Speaker 2: put that as part of our application. We put that
• 19:42
  Speaker 2: in front of the societies and we got their feedback. Yeah,
• 19:44
  Speaker 2: we agree, that's a nice sample size. You know, the
• 19:46
  Speaker 2: VMAP study, that's a big number. Two hundred and fifty
• 19:49
  Speaker 2: five Rhythm episodes. Oh, we like this study as well.
• 19:52
  Speaker 2: We liked reading about your improvements and VT outcomes for
• 19:57
  Speaker 2: human dynamically unstable that's a really important group that's underserved.
• 20:01
  Speaker 2: That sort of feedback has been in the process so
• 20:04
  Speaker 2: widespread use. Then we'll talk about clinical evidence, and then
• 20:08
  Speaker 2: finally that third element that I talked about which we
• 20:10
  Speaker 2: benefited from, which is the conversation and the dialogue with societies.
• 20:14
  Speaker 1: Yeah, I think that's I feel like you're just doing
• 20:16
  Speaker 1: a lot of your prep work before jumping in to
• 20:19
  Speaker 1: kind of get that transition. It's interesting that you talked
• 20:23
  Speaker 1: about the chemo dynamic unstable VT study because I look
• 20:31
  Speaker 1: read through that and that you know, spoiler alert, the
• 20:35
  Speaker 1: eighty percent of the patients who utilize VMAP were free
• 20:41
  Speaker 1: from the VT after a year versus forty three percent
• 20:45
  Speaker 1: of the patients that didn't. What is fascinating there is
• 20:50
  Speaker 1: the forty three is far less than kind of what
• 20:55
  Speaker 1: you're seeing with traditional AF procedures. Now, with the right
• 21:00
  Speaker 1: of PFA or dual energy, you're kind of seeing that
• 21:02
  Speaker 1: eighty percent freedom kind of almost being the norm there.
• 21:05
  Speaker 1: But this unstable VT was so low at forty three percent.
• 21:10
  Speaker 1: It seems like a very sick population pool there, and
• 21:14
  Speaker 1: then being able to then raise that up to that
• 21:17
  Speaker 1: eighty percent with the use of VMAP. I'd love to
• 21:20
  Speaker 1: hear your thoughts about, you know, why that was the
• 21:23
  Speaker 1: case and if my thoughts initial thoughts there are in
• 21:28
  Speaker 1: the right direction.
• 21:30
  Speaker 2: The VT paper that you're speaking about is a phenomenal
• 21:35
  Speaker 2: bit of research and is really groundbreaking, so let's talk
• 21:37
  Speaker 2: about it and why it's so interesting. So, first of all,
• 21:40
  Speaker 2: just published this year EuroPace, a phenomenal electrophysiology periodical, and
• 21:48
  Speaker 2: what we're looking at is, as you mentioned, an incredibly
• 21:51
  Speaker 2: sick group of patients. So hemodynamically unstable. VT is just
• 21:57
  Speaker 2: a fancy way of thinking about a patient where their
• 22:00
  Speaker 2: rhythmia can be self sustaining, and if we put them
• 22:05
  Speaker 2: in a situation that you would in a normal VT inmplation,
• 22:08
  Speaker 2: you actually can cause them to go into a repetitive
• 22:11
  Speaker 2: cycle where their blood pressure drops and you have to
• 22:14
  Speaker 2: intervene to keep them alive. So electrophysiologists don't traditionally like
• 22:19
  Speaker 2: this group of patients to treat because it's scary and
• 22:22
  Speaker 2: you don't want to kill a patient by trying to
• 22:24
  Speaker 2: treat their arrhythmia. So they'll often send these patients to
• 22:27
  Speaker 2: academic centers and even at the best centers in the world,
• 22:31
  Speaker 2: forty five percent success rates in these cases is the
• 22:35
  Speaker 2: norm because you try to go in and invasively map
• 22:39
  Speaker 2: to figure out where the triggers of the arrhythmia are.
• 22:42
  Speaker 2: And the problem is that patient boom, they dropped. Now
• 22:46
  Speaker 2: you got to shock them back to life, and how
• 22:47
  Speaker 2: many times do you want to do is with this
• 22:49
  Speaker 2: incredibly sick patient. So what we do in the VMAP,
• 22:52
  Speaker 2: the use of VMAP is we're able to get the
• 22:55
  Speaker 2: insights that we would need to treat the patient from
• 22:58
  Speaker 2: their ECG. Now I don't have to put them in
• 23:01
  Speaker 2: a condition multiple times where they're going to drop and
• 23:04
  Speaker 2: I need to shock them back to life. Now I
• 23:06
  Speaker 2: can intervene, treat that area and do it in a
• 23:09
  Speaker 2: much safer way. So the electrophysiologists now can can really
• 23:13
  Speaker 2: deal with with fighting this patient's disease in a way
• 23:17
  Speaker 2: that's not putting them in jeopardy of death.
• 23:20
  Speaker 1: Yeah, and I think you know that kind of unlocks
• 23:23
  Speaker 1: a new potential patient pool there because of that ability
• 23:27
  Speaker 1: to get like you said, doing all that information gained
• 23:30
  Speaker 1: all that information beforehand from an external ECG just seems
• 23:33
  Speaker 1: like a powerful tool there. We also had, you know,
• 23:38
  Speaker 1: there's two other studies that were, you know, on my radar.
• 23:42
  Speaker 1: First was the vital EP study, and that was for
• 23:48
  Speaker 1: the ablation procedures that were guided by the map. So
• 23:53
  Speaker 1: how is that different from what we were kind of
• 23:55
  Speaker 1: talking about earlier in this conversation, where you you know,
• 23:59
  Speaker 1: you can use it before as you're kind of pre
• 24:02
  Speaker 1: planning tool, you can utilize it during the procedure. Is
• 24:06
  Speaker 1: that simply a further evidence about utilizing it within the
• 24:12
  Speaker 1: procedure itself.
• 24:14
  Speaker 3: Yeah.
• 24:14
  Speaker 2: So the vital EP study is a one hundred and
• 24:17
  Speaker 2: ten patient study at five different sites, actually one hundred
• 24:20
  Speaker 2: and twelve patients, and it really was focused on, as
• 24:24
  Speaker 2: you say, its use in guiding per procedure during procedure oblation.
• 24:31
  Speaker 2: And it was a real world registry, so it was
• 24:34
  Speaker 2: kind of first come, first serve. We didn't try to
• 24:36
  Speaker 2: weed out any patients. We didn't say, oh, we're not
• 24:38
  Speaker 2: going to treat those patients. We just first one hundred
• 24:41
  Speaker 2: and twelve that came through at those five sites, and
• 24:44
  Speaker 2: what we were really focused on is workflow efficiencies because
• 24:48
  Speaker 2: when you start to talk about personalized medicine, you start
• 24:51
  Speaker 2: to talk about what does that do to the length
• 24:54
  Speaker 2: of the procedure. How long am I going to keep
• 24:56
  Speaker 2: that patient on the table? Am I going to interrupt
• 24:59
  Speaker 2: the doctor's workflow? Are we going to add additional risk?
• 25:03
  Speaker 2: And the exciting thing what we looked at is we
• 25:06
  Speaker 2: could provide personalized medicine in an incredibly fast and safe way.
• 25:13
  Speaker 2: And so let's just give an example what we looked at,
• 25:15
  Speaker 2: and this has been published. We've submitted one hundred and
• 25:19
  Speaker 2: twelve patients for full manuscript, so I can't go into
• 25:20
  Speaker 2: the full numbers, but for the thirty four that we
• 25:23
  Speaker 2: talked about at afsymposium this year, what we saw is
• 25:27
  Speaker 2: we were able to treat the first early cohort of
• 25:30
  Speaker 2: about thirty four patients in a total procedure time of
• 25:33
  Speaker 2: seventy minutes. Now that's a fast procedure for personalized medicine.
• 25:38
  Speaker 2: And what do I mean by that, Well, I have comparitors.
• 25:40
  Speaker 2: There's two other studies. It's not my data, it's their data.
• 25:43
  Speaker 2: But two other studies came out. One was called tailored
• 25:46
  Speaker 2: a AFF and one was called flow AFF and those
• 25:48
  Speaker 2: are also personalized ablation AF ablation technologies, and in the
• 25:55
  Speaker 2: tailored a AFF they had approximately one hundred and seventy minutes
• 25:59
  Speaker 2: of procedure time, and in the flow AFF, I believe
• 26:02
  Speaker 2: it was more maybe one hundred and eighty. When we're
• 26:06
  Speaker 2: talking about, as we spoke at the beginning of the conversation,
• 26:09
  Speaker 2: we need to get more patients through, We need to
• 26:11
  Speaker 2: make sure that more patients are treated early, and doctors
• 26:16
  Speaker 2: are now using technologies like pulse field ablation where we
• 26:18
  Speaker 2: can go faster. We can't then add a mapping technology
• 26:22
  Speaker 2: that slows them down.
• 26:24
  Speaker 1: Right Deece the whole purpose of having the technical the
• 26:26
  Speaker 1: advantages of PFA there exactly.
• 26:28
  Speaker 2: So we were delighted to say, look, we've got all
• 26:31
  Speaker 2: the benefits of personalized mapping and we did it quickly
• 26:34
  Speaker 2: without disrupting your workflow. So that was the super exciting
• 26:37
  Speaker 2: thing about vital The other thing, and I mentioned I
• 26:41
  Speaker 2: have kind of speaking here with a smile on my face,
• 26:44
  Speaker 2: because the interesting thing about vitallyp was it was all
• 26:48
  Speaker 2: used in the procedure, but the study itself demonstrated the
• 26:52
  Speaker 2: flexibility of the technology because more than fifty percent of
• 26:57
  Speaker 2: the patients were mapped before they ever had vascular access,
• 27:02
  Speaker 2: So before anything was put inside the patient, we were
• 27:05
  Speaker 2: able to map them. And so that shows you that
• 27:08
  Speaker 2: you can use the technology in a way, whether it
• 27:10
  Speaker 2: was in the clinic three days before, whether it's as
• 27:13
  Speaker 2: we've draped the patient and they're just sitting there with
• 27:15
  Speaker 2: their ECG and they're waiting for the physician to start
• 27:18
  Speaker 2: getting access to their heart, or you can use it
• 27:20
  Speaker 2: in the procedure and you still get these these procedural
• 27:23
  Speaker 2: workflow benefits.
• 27:25
  Speaker 1: And then just another just to the workflow process as well.
• 27:30
  Speaker 1: Because you know, with our dive into AF related companies
• 27:35
  Speaker 1: EP companies, you know you're thinking of you know, Boston,
• 27:38
  Speaker 1: there's a leader in the PFA, but you have companies
• 27:42
  Speaker 1: like Jane Jay and Abbott who are leaders in the mapping,
• 27:45
  Speaker 1: which kind of gets put under you know, it's under
• 27:47
  Speaker 1: the radar compared to the kind of the PFA headlines
• 27:49
  Speaker 1: that you see. But how does vmap when it does
• 27:55
  Speaker 1: you know, you're you're doing your mapping beforehand, how does
• 27:58
  Speaker 1: that then translate into Jane Jay's cardo and Abbott's in
• 28:02
  Speaker 1: sight as that's the one that's connected to the catheter
• 28:06
  Speaker 1: and helping the EPs understand where within the heart to
• 28:11
  Speaker 1: put the catheter once the catheter is in the body.
• 28:14
  Speaker 2: Yeah, there's a lot of different technologies going on, and
• 28:16
  Speaker 2: I think they all just deserve a little bit of
• 28:20
  Speaker 2: explanation and how they work together. So you started with
• 28:25
  Speaker 2: pulse field deblation catheters. Those are the newest technologies in
• 28:28
  Speaker 2: catheters that have been shown to deliver a safe and
• 28:33
  Speaker 2: effective treatment much faster and over a larger area than
• 28:37
  Speaker 2: prior technologies. So that's great, we've democratized the energy source delivery.
• 28:42
  Speaker 2: The other side of that equation in having a successful
• 28:45
  Speaker 2: evation procedure is mapping. And so you correctly say that
• 28:50
  Speaker 2: Johnson and Johnson and Abbott and other companies Boston and Metronic,
• 28:56
  Speaker 2: they all have mapping technologies and those mapping technologies are
• 29:00
  Speaker 2: called three D electro atomic mapping. And what they do
• 29:03
  Speaker 2: is they put a different type of catheter or a
• 29:06
  Speaker 2: pulse field ablation catheter with some sensing technologies, but they
• 29:09
  Speaker 2: put it inside the heart and they move it so
• 29:11
  Speaker 2: they can get an idea of what the inner surface
• 29:13
  Speaker 2: of the heart looks like. Everyone's heart looks a little differently,
• 29:16
  Speaker 2: and you need to know where you're ultimately going to
• 29:18
  Speaker 2: put that burning catheter or that ablation catheter, and where.
• 29:21
  Speaker 3: You're going to treat.
• 29:22
  Speaker 2: So you've got the energy source, you've got these electro
• 29:27
  Speaker 2: anatomic MAPP three D mapping systems that show you what
• 29:30
  Speaker 2: the inner surface of the heart looks like. And what
• 29:32
  Speaker 2: you have with our technology is a complementary technology because
• 29:37
  Speaker 2: we're providing totally different, different information. We're providing where based
• 29:42
  Speaker 2: on your ECG is your rhythmia coming from. And if
• 29:45
  Speaker 2: you put all three of those things together, then you
• 29:48
  Speaker 2: have the recipe for what you need to treat this patient.
• 29:51
  Speaker 1: Right, you're kind of almost creating. You know, when I'm
• 29:53
  Speaker 1: thinking of Google Maps and I'm going from my house
• 29:56
  Speaker 1: to locate like to even here in the Bloomberg head
• 30:01
  Speaker 1: I need to know where the Bloomberg headquarters is first
• 30:03
  Speaker 1: before I Google Maps can create the map from my
• 30:05
  Speaker 1: house to seven thirty one Lex. It sounds like vmap
• 30:10
  Speaker 1: is telling the doctors or the EPs to put in
• 30:14
  Speaker 1: seven thirty one Lex into the destination in my Google Maps.
• 30:17
  Speaker 1: Is that is that kind of a way to think
• 30:19
  Speaker 1: about it.
• 30:19
  Speaker 2: I love that analogy because it's I've heard it several times,
• 30:23
  Speaker 2: not just here, but also from physicians.
• 30:25
  Speaker 3: We have been described as.
• 30:26
  Speaker 2: The Google Google Maps of arrhythmia, which simply means that
• 30:31
  Speaker 2: you can get in your car and you can drive,
• 30:32
  Speaker 2: but you're not going to end up here in Bloomberg
• 30:34
  Speaker 2: unless you know where the address is. And that's exactly
• 30:37
  Speaker 2: what we're providing. We're saying, hey, it's on this street.
• 30:40
  Speaker 2: We're on Lexington Avenue, and you need to send your
• 30:43
  Speaker 2: car in that direction. And so we do send all
• 30:45
  Speaker 2: the tools towards the direction of the arrhythmia, and then
• 30:47
  Speaker 2: we can get there, we can treat it, and then
• 30:50
  Speaker 2: we can be done.
• 30:52
  Speaker 1: Interesting. Yeah, no, it's like I said, this has been
• 30:54
  Speaker 1: a great conversation just to understand you know where vmap
• 30:57
  Speaker 1: fits in that I mean full pun intended map here
• 31:01
  Speaker 1: and so yeah, no, it's it's it's a great understanding.
• 31:04
  Speaker 1: It kind of then leads to then, you know, well
• 31:07
  Speaker 1: let's start let's you know, we talked about the vital EP.
• 31:10
  Speaker 1: Let's then you know, the other major study out there
• 31:13
  Speaker 1: is the Improved AF study. What's what's the design for
• 31:16
  Speaker 1: that and what's the timeline for kind of seeing some
• 31:20
  Speaker 1: data come out for that study?
• 31:22
  Speaker 2: So the Improved Study is a major international study that
• 31:26
  Speaker 2: we embarked on to help demonstrate the effectiveness of VMAP
• 31:31
  Speaker 2: when used in nature of fibrillation. And so we're looking
• 31:34
  Speaker 2: at a population of patients with persistent AF or patients
• 31:38
  Speaker 2: who have gone in for treatment and it wasn't unsuccessful.
• 31:42
  Speaker 2: And why is that so important is because we feel
• 31:45
  Speaker 2: like we're pretty successful with those early group of patients,
• 31:48
  Speaker 2: the ones who do manage to come in with paroxysmal
• 31:51
  Speaker 2: or intermittent AF. But once you get past a certain point,
• 31:55
  Speaker 2: we really without technologies like VMAP, don't know where to
• 31:59
  Speaker 2: what to do. And so we do anatomical ablation called
• 32:03
  Speaker 2: pulmonary vein isolation, which for these patients is about fifty
• 32:07
  Speaker 2: to sixty percent successful, and that's not great for an
• 32:10
  Speaker 2: invasive procedure where we're going to damage heart tissue. So
• 32:13
  Speaker 2: what we're trying to do is in this multi center
• 32:17
  Speaker 2: international study sites twenty seven sites in the US in Europe,
• 32:21
  Speaker 2: in a randomized way against a control using the standard
• 32:23
  Speaker 2: of care, demonstrate how VMAP guided ablation can improve outcomes
• 32:30
  Speaker 2: for these for this group of patients. And we're really
• 32:33
  Speaker 2: excited about where we are, so we'll have over when
• 32:36
  Speaker 2: we're done, we'll have over four hundred patients enrolled and
• 32:38
  Speaker 2: we're rolling ahead of our estimates, so we actually have
• 32:41
  Speaker 2: I believe about three hundred and twenty patients enrolled already
• 32:43
  Speaker 2: in the study. We'll follow those patients for at least
• 32:46
  Speaker 2: a year, and we'll show how their outcomes changed by
• 32:50
  Speaker 2: just like the VT study, how their outcomes changed by
• 32:53
  Speaker 2: using VMAP rather than just the standard of care.
• 32:56
  Speaker 1: Okay, so I put if I'm doing, if I'm crunching
• 32:58
  Speaker 1: the numbers, you know, we're in July of twenty twenty six.
• 33:02
  Speaker 1: You know, sounds like more than three quarters away done
• 33:06
  Speaker 1: with the enrollment. We can get enrollment done potentially third quarter.
• 33:11
  Speaker 1: If it gets done third quarter, twelve month follow up.
• 33:15
  Speaker 1: That sounds like something late twenty twenty seven, early twenty
• 33:18
  Speaker 1: twenty eight. We could see some potential data if I'm
• 33:20
  Speaker 1: based off of my math.
• 33:22
  Speaker 2: Yeah, and I look forward to coming back and sharing
• 33:23
  Speaker 2: the data with you next year in the fall. And
• 33:26
  Speaker 2: that's exactly right, your spot on. Our goal is to
• 33:28
  Speaker 2: finish enrollment this fall. We'll follow all of the patients
• 33:32
  Speaker 2: through the twelve month time period, and then we hope
• 33:35
  Speaker 2: to gather the data, work with the researchers to write
• 33:40
  Speaker 2: up a manuscript and get it published. But Yeah, I'm
• 33:43
  Speaker 2: really really excited about that, and hopefully we'll be having
• 33:47
  Speaker 2: a great conversation in late fall.
• 33:49
  Speaker 3: Or maybe the winter of next year.
• 33:51
  Speaker 1: Yeah, I'm looking forward to that as well. But I
• 33:54
  Speaker 1: have to take a step back because you know, we
• 33:57
  Speaker 1: were talking earlier about you know, two and cases through
• 34:01
  Speaker 1: twenty twenty five and then three thousand in just this
• 34:05
  Speaker 1: year alone, is what your your expectations are. But I'm
• 34:11
  Speaker 1: curious between those all those cases and we're just talking
• 34:14
  Speaker 1: about with improved AF. You know, as you guys are
• 34:16
  Speaker 1: looking into expanding into AF, are most of the cases
• 34:20
  Speaker 1: that you're currently doing within other cardiac arrhythmias like the
• 34:24
  Speaker 1: unstable VT cases.
• 34:27
  Speaker 2: So it's interesting because we're able to analyze so many
• 34:32
  Speaker 2: different rhythmias. We actually find that our technology matches the
• 34:37
  Speaker 2: demand that's available in the hospitals that we're at. So
• 34:40
  Speaker 2: actually ask the team to look at our proportion of
• 34:43
  Speaker 2: cases in let's say AF versus VT or PVCs, and surprisingly,
• 34:49
  Speaker 2: or maybe not surprisingly, our numbers largely fit the market.
• 34:53
  Speaker 2: It's not based on any specific type, but we do
• 34:56
  Speaker 2: roughly forty percent of our cases our hrofibrillation or vital flutter.
• 35:00
  Speaker 2: Those cases often go hand in hand. About fifteen percent
• 35:04
  Speaker 2: of our cases are VT cases and about thirty percent
• 35:07
  Speaker 2: of our cases are PVCs, and that really matches the
• 35:10
  Speaker 2: patients that go in for oblations, and so it demonstrates,
• 35:14
  Speaker 2: at least in my mind, really strong product market fit,
• 35:17
  Speaker 2: but also a technology that meets the needs of the
• 35:21
  Speaker 2: doctors and the patients they're treating.
• 35:23
  Speaker 1: Interesting, and then you know, we finally get into the
• 35:26
  Speaker 1: next generation of VMAP. The question I had when we
• 35:31
  Speaker 1: were talking about the locked versions of vmaps that get
• 35:35
  Speaker 1: delivered to the doctors is I'm curious because you know,
• 35:39
  Speaker 1: it's I'm thinking about my iPhone and then there's other
• 35:43
  Speaker 1: medical technology companies where you have a hardware and then
• 35:47
  Speaker 1: you can get software updates, so like I can update
• 35:50
  Speaker 1: the new iOS system on my iPhone overnight and I
• 35:53
  Speaker 1: have the new iOS system. But it sounds like for
• 35:56
  Speaker 1: VMAP and for kind of AI in general, you don't
• 35:59
  Speaker 1: want to do that. You don't want to send over
• 36:02
  Speaker 1: a upgraded software until the next generation comes out, and
• 36:07
  Speaker 1: that's a locked version. Am I thinking about that the
• 36:09
  Speaker 1: right way?
• 36:10
  Speaker 2: Well, it's exactly right, and it's really based on a
• 36:12
  Speaker 2: safety that the FDA, I think correctly has put into
• 36:18
  Speaker 2: the into the market. We don't want systems that hallucinate clearly,
• 36:23
  Speaker 2: especially when we're dealing with you know, guiding potential, you know,
• 36:27
  Speaker 2: oblation strategies. But the other thing is that all of
• 36:32
  Speaker 2: our technologies require rigorous testing. So anytime we do a
• 36:37
  Speaker 2: software update, we have a slew of dozens and dozens
• 36:40
  Speaker 2: of tests against a base set of patients.
• 36:43
  Speaker 3: That we have their their data on and.
• 36:47
  Speaker 2: We make sure that anytime we make a change to
• 36:49
  Speaker 2: the software, it only gets better. And that's that's really
• 36:52
  Speaker 2: important to do before you release.
• 36:54
  Speaker 3: A new software. And so.
• 36:57
  Speaker 2: You know, like I said, we do about two to
• 36:59
  Speaker 2: three upgrades year. We test them rigorously, we go through
• 37:03
  Speaker 2: the processes whether we need FDA additional FDA clearance or
• 37:06
  Speaker 2: just a letter to file, and we again we speak
• 37:10
  Speaker 2: hand in hand with FDA on this all the time,
• 37:12
  Speaker 2: so it's been a great partnership. Then we roll them out.
• 37:15
  Speaker 2: And the amazing part about software as a medical device
• 37:20
  Speaker 2: is the flexibility you can provide for the patients based
• 37:24
  Speaker 2: on what the doctors want. And I'll just give you
• 37:25
  Speaker 2: a couple of examples because I think it's exciting to
• 37:28
  Speaker 2: think about what we're talking about. So when we do
• 37:31
  Speaker 2: a map of a patient's aridenia and you think about
• 37:34
  Speaker 2: a heart, our typical output is, hey, it's on It'll
• 37:38
  Speaker 2: it'll show a three D image of the heart and
• 37:41
  Speaker 2: there'll be a colored area and it'll be red or
• 37:43
  Speaker 2: white where it's most likely to be coming from. So
• 37:46
  Speaker 2: pretty easy to read. But one of the interesting things
• 37:49
  Speaker 2: is doctors often have a basic question that's that's a
• 37:53
  Speaker 2: little bit different than where is it in the heart?
• 37:55
  Speaker 2: Just is it on the left side of my heart?
• 37:58
  Speaker 2: Or is it on the right side of my heart?
• 38:00
  Speaker 2: And you're why does that matter? Well, interestingly, right sided cases,
• 38:04
  Speaker 2: if you're rhythen me is on your right ventricle and
• 38:08
  Speaker 2: the right chamber of your ventricle. That is a much
• 38:10
  Speaker 2: easier case for an electrophysiologists than having to take their
• 38:16
  Speaker 2: catheter and puncture the septa wall and then go into
• 38:19
  Speaker 2: the left side or find a different access. So one
• 38:22
  Speaker 2: of the one of the most requested features we had
• 38:25
  Speaker 2: a few years ago is can you tell us whether
• 38:27
  Speaker 2: it's left or right sided? So we did that, we
• 38:31
  Speaker 2: rolled it out. It took about six months to figure
• 38:33
  Speaker 2: out the math. And that's what our technology is. It's
• 38:36
  Speaker 2: just a really, really glorious math problem. Then it solves
• 38:40
  Speaker 2: all the time, and that's what computers are really.
• 38:43
  Speaker 3: Really good at.
• 38:44
  Speaker 2: But we were able to in about six months roll
• 38:46
  Speaker 2: out of left versus right with over ninety percent accuracy,
• 38:50
  Speaker 2: which is so much better than humans can do. It's
• 38:53
  Speaker 2: it's exciting, and again I can provide that information in
• 38:56
  Speaker 2: less than a minute. Yeah, going forward in time, there's
• 38:59
  Speaker 2: two other advances I think I'd really like to talk about,
• 39:02
  Speaker 2: because we just got a second FDA clearance this past fall.
• 39:07
  Speaker 2: First is we added a new arrhythmia, so we added
• 39:10
  Speaker 2: atrial flutter. We had initially been cleared for seven arrhythmias.
• 39:14
  Speaker 2: We added an eighth, which is atrial flutter. And the
• 39:16
  Speaker 2: interesting part about atrial flutter is, as I said before,
• 39:19
  Speaker 2: it often goes hand in hand with atrial fibrillation. And
• 39:21
  Speaker 2: so you might be treating a really complex atrial fibrillation
• 39:24
  Speaker 2: case and suddenly the arrhythmia you treat it and it
• 39:28
  Speaker 2: devolves into an atrial flutter, which is essentially a re
• 39:31
  Speaker 2: entrance circuit, a series of electrical current that goes around
• 39:35
  Speaker 2: a pattern. And in those cases interestingly related to the
• 39:40
  Speaker 2: left versus right, our system can very quickly tell you
• 39:43
  Speaker 2: whether it's a typical or atypical flutter long before or
• 39:49
  Speaker 2: faster than you might as an electricasiologist. So that was
• 39:51
  Speaker 2: really exciting. The last one I want to talk about,
• 39:54
  Speaker 2: and again it goes into a theme that I keep
• 39:56
  Speaker 2: trying to bring up, which is workflow, is that we
• 39:58
  Speaker 2: added the opportunity to interface or integrate with some of
• 40:04
  Speaker 2: the ECG acquisition systems. So you think of the other
• 40:09
  Speaker 2: technology we mentioned some of them before. In every EP
• 40:12
  Speaker 2: lab there's an ep ECG recorder, so it takes the
• 40:16
  Speaker 2: twelve ADCG, it pulls it into the recording system, and
• 40:19
  Speaker 2: it keeps a record of the case. What we've been
• 40:21
  Speaker 2: able to build is the streaming ability to pull that
• 40:24
  Speaker 2: ECG directly from the ECG recording system and instead of
• 40:28
  Speaker 2: having to manually take it out of the recorder and
• 40:31
  Speaker 2: put into our system, now we have the opportunity to
• 40:34
  Speaker 2: just stream all of that beautiful data into vmap and
• 40:37
  Speaker 2: map it more quickly and then put the data out
• 40:41
  Speaker 2: and be able to put our output onto one of
• 40:45
  Speaker 2: those systems that you've talked about before. So that's the
• 40:47
  Speaker 2: complementary nature. How do we how do we have a
• 40:49
  Speaker 2: tie that lifts all boats, Well, we improve the workflow,
• 40:53
  Speaker 2: we pull the ECG in faster. We did that, and
• 40:56
  Speaker 2: then now we're going to be working on pushing our
• 40:58
  Speaker 2: output on so you can see it by side or
• 41:00
  Speaker 2: even overlaid on that anatomical map that we talked about earlier.
• 41:05
  Speaker 1: Yeah, I mean that sounds like a fascinating update there.
• 41:08
  Speaker 1: But you know, we've talked a lot of you know
• 41:09
  Speaker 1: we're talking about and we even actually talk about the
• 41:14
  Speaker 1: ce MARK yet. But there's a lot of different developments
• 41:17
  Speaker 1: that you're going through between you know, the vital EP results,
• 41:21
  Speaker 1: the improve af studying gain that enroll, the next generation
• 41:24
  Speaker 1: mapping coming out ce MARK, putting on your CEO hat.
• 41:29
  Speaker 1: How do you go about prioritizing all these you know,
• 41:34
  Speaker 1: exciting different developments that are going on, because at some
• 41:38
  Speaker 1: point you need to sleep and so you know, you like,
• 41:43
  Speaker 1: how do you be able to fit all this into
• 41:45
  Speaker 1: like that twenty four hour timeline.
• 41:47
  Speaker 3: Well, it's funny that you said that.
• 41:48
  Speaker 2: I was just speaking with my head of product and
• 41:51
  Speaker 2: he likes to say that he'll sleep when he when
• 41:53
  Speaker 2: he dies, but outside of that, the rest of us
• 41:56
  Speaker 2: do like to get a little bit of sleep, and
• 41:58
  Speaker 2: so prioritization is is one of the most important things
• 42:01
  Speaker 2: we can do.
• 42:01
  Speaker 3: And I think it's.
• 42:03
  Speaker 2: About thinking of doing some things really well before you
• 42:08
  Speaker 2: decide to do the next thing. And so we try
• 42:11
  Speaker 2: to stay super focused on just a few key things
• 42:15
  Speaker 2: at a time, typically three or four things, and then
• 42:18
  Speaker 2: we'll assign project leaders to those three or four things
• 42:20
  Speaker 2: and make sure we're really dialed in on that before
• 42:23
  Speaker 2: you do the next thing. Because again, because you can
• 42:26
  Speaker 2: with software chase any different idea you get it from electrophysiologists,
• 42:30
  Speaker 2: you could be doing fifteen different projects at the same time. Yeah,
• 42:33
  Speaker 2: and the key you don't want to disappoint anybody. You
• 42:36
  Speaker 2: don't want to disappoint a physician or provide a service
• 42:39
  Speaker 2: that doesn't provide value.
• 42:40
  Speaker 3: And so.
• 42:43
  Speaker 2: You know, we really look at what's our what is
• 42:45
  Speaker 2: the base of what we do well. We're a fast,
• 42:47
  Speaker 2: efficient mapping system, So how do we keep doing that,
• 42:50
  Speaker 2: and how do we keep evolving that so it gets faster,
• 42:53
  Speaker 2: gets more accurate, gets more precise, And then you know,
• 42:57
  Speaker 2: the next bucket, how do we make sure we're in
• 42:59
  Speaker 2: a graded into the entire care pathway from the beginning
• 43:04
  Speaker 2: of the patient's journey until later in the patient's journey.
• 43:07
  Speaker 2: Those are some of our key focus areas.
• 43:09
  Speaker 1: Interesting that kind of then just kind of you know,
• 43:11
  Speaker 1: we'll close out here and you're talking about these focuses,
• 43:15
  Speaker 1: you know, being a streamline mapping company, being fully integrated
• 43:18
  Speaker 1: with these companies. I guess with that said, you how
• 43:21
  Speaker 1: do you envision just the non invasive mapping market in
• 43:26
  Speaker 1: the next five years. Let's say, obviously the end goal
• 43:31
  Speaker 1: is to be part of every case, but is there
• 43:33
  Speaker 1: more to it than just that.
• 43:36
  Speaker 3: Yeah, there's a lot more at base.
• 43:38
  Speaker 2: We want to have non invasive mapping the analysis, the
• 43:41
  Speaker 2: mathematical analysis of twelve d DCG done by a computer
• 43:45
  Speaker 2: to truly be a part of every case because it's
• 43:48
  Speaker 2: it's fast, it adds additional information that isn't in the case,
• 43:52
  Speaker 2: and it always provides an opportunity for a better outcome
• 43:55
  Speaker 2: for the patient. So we should be pushing that for
• 43:58
  Speaker 2: every case we can. First, but second, and this is
• 44:03
  Speaker 2: our next key focus, is we're not limited to providing
• 44:08
  Speaker 2: help in that lab. We're not limited to the ability
• 44:11
  Speaker 2: to guide the doctor as he or she is treating
• 44:14
  Speaker 2: the patient at that moment. Because it's the twelve lead,
• 44:17
  Speaker 2: because it's the most used testing cardiology, every single time
• 44:21
  Speaker 2: the patient interacts with our medical system, we can provide
• 44:23
  Speaker 2: information on how to treat them better. And so sometimes
• 44:26
  Speaker 2: the patient is going to come into the emergency department,
• 44:29
  Speaker 2: that ECG is going to get put into a database.
• 44:32
  Speaker 2: And the incredible part is we can analyze it. We
• 44:35
  Speaker 2: can analyze it then and say, you know, mister Smith,
• 44:39
  Speaker 2: you have a very treatable PBC. Let's talk about getting
• 44:42
  Speaker 2: you in now before this gets worse.
• 44:45
  Speaker 1: Yeah, and I look forward to seeing how that plays
• 44:47
  Speaker 1: out over the next few years. But Rob, thanks so
• 44:50
  Speaker 1: much for joining us today.
• 44:51
  Speaker 2: Matt, thanks for having me. It's been a delight and
• 44:53
  Speaker 2: look forward to our next interaction.
• 44:55
  Speaker 1: Absolutely, and thank you to our producers at Didisimani and
• 44:58
  Speaker 1: mariam Tha Wailey for all the behind the scenes work.
• 45:01
  Speaker 1: And thank you to our listeners for tuning in today.
• 45:03
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• 45:05
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• 45:07
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