The market for capital equipment in hospitals is slow moving given long product life spans and tight hospital budgets. Your nearest X-ray may have moved into town before you did, the ultrasound machine remembers the hooplah of the first iPhone, and who knows, that MRI machine's first memory might be you hopping on the Feist bandwagon.

However, we find ourselves in a unique historical moment: there is one segment of capital equipment that is heating up. There are new entrants, accelerating technological development, new scientific theories and big money at stake. Abandon your preconceived notions of capital equipment, dear reader, and delve into the wild world of electrophysiology (EP) mapping systems.

One of several pieces of equipment that make up an EP lab, most mapping systems generate 3-D images of the heart showing the distribution of electrical activity. This information is collected by diagnostic catheters fed into the heart. The map tells a physician where to burn heart tissue to isolate arrant electrical signals and if the isolation is successful. This technology is essential for atrial fibrillation (AF) ablation which is growing rapidly.

There are two competitors in this space: Biosense Webster, the leader of the cardiac ablation market, and St Jude Medical, each offering a 3-D mapping system. The majority of US EP labs have both systems. The first wave of change came when Boston Scientific launched a new high resolution 3-D mapping system, Rhythmia, late last year. Not to be out maneuvered, St Jude is expected to release their own top-secret high resolution system later this year.

And of course there is Abbott, the colossus of the cardiac device world, buying Topera late last year and swiftly spreading the gospel of rotor mapping, a controversial theory on the origins of AF that hopes to improve procedure success rates. Abbott's product is meant to be used with 3-D mapping systems, making picking the second mapping system for an EP lab more complicated.

And just as we thought the dust had settled Medtronic crashes the show by buying CardioInsight and their non-invasive 3-D mapping system in June. This technology uses skin electrodes and CT-scans to generate a 3-D map, all without catheters inside the body. This system still needs technical refinement but if it proves to be viable, the mapping system market will never be the same again.

Like nature, medtech markets seem to provide exceptions to every rule. A growing number of players, new scientific theories and even improving reimbursement for ablation (from a hospital perspective) all make the electrophysiology mapping space a market for the ages. I just hope their long memories don't include my inititial enthusiasm for my FitBit, now collecting dust at home.

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