The HRS annual conference for electrophysiologists has come and gone for another year and, as usual, left attendees with a lot to think about over the next 12 months.

So far as the issue of improving the safety and efficacy of catheter ablation is concerned, there are a number of new technologies currently being used or in the pipeline, all of which promise to improve the EP field for both patients and physicians. For example, a number of speakers highlighted the increased safety and improved outcomes offered by second-generation cryoballoons over their first-gen counterparts. Dr.  Ellen Hoffman pointed out that outcomes for the Arctic Front Advanced improved 10 points over its predecessor.

But, as Dr. Boris Schmidt pointed out in his presentation, what about the learning curve associated with using this new device. Dr. Schmidt cited a study showing that complication rates jumped markedly for those physicians performing fewer than 25 ablations every year. Given this trend, a simple, easy-to-learn technology might better shake up the future of electrophysiology. Behold the laser balloon, a device that purports to offer reduced procedure time, similar efficacy, and a gentle learning curve.

Not so fast, said Dr. Fermin Garcia let's not throw out the baby with the bathwater. RF ablation has been successful for years; we merely need to improve upon it. Circular RF ablation promises that an increased number of electrodes will create a near foolproof device that can be used with existing lab systems AND reduces the learning curve for less seasoned physicians.

But electrophysiologists aren't the only ones throwing their hats into the Afib ring. Speakers suggested that the applicability of left atrial appendage occlusion devices have been attested to overseas for years, while cardiologists made strong statements in favor of CRTs for addressing similar indications.

If this isn't all confusing enough, there were some who questioned the viability of electrophysiology going forward. Kevin Campbell, speaking about the ACA, railed against reimbursement cuts recommended by the Medicare Payment Advisory Committee, asking important questions: Is innovation going to slow due to the effects of the medical device excise tax. Will there be as much interest in electrophysiology among physicians when physician reimbursement is cut by nearly 25% in the next several years.

Whether we're talking about new devices, alternative treatments, or the changing reimbursement environment, these are all complex issues that could have a significant impact on the future of catheter ablation and the electrophysiology field at large in the years to come. We'll have to wait and see.

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