[00:00:00] Speaker A: Hi, everybody. This is Tom Salemi of Device Talks. Welcome to the Abbott Talks podcast. Over the past few years, the world has come to recognize Abbott as a company dedicated to helping people live happier and healthier lives. In this podcast series, we'll talk with the healthcare leaders, the executives and the engineers who are working every day to develop new technologies to help people live their best lives.
I know you'll enjoy this episode of the Abbot Talks podcast.
Hello, everyone. This is Tom Salemi. Welcome to the to season three of the Abbott Talks podcast. So very happy to have Abbott back as one of our, our most favorite podcast partners. Also very happy to have with me we're mixing things up a bit. Kayleen Brown, our esteemed managing editor of Device Talks, is, is joining us on season three. Kayleen, great to have you as a co host.
[00:00:59] Speaker B: Oh, I am so beyond thrilled. Vish can probably see, you can probably see, Tom, that I'm champing at the bit here. When I first joined Device Talks two years ago today, the recording date. Thank you. My very first podcast that I had the privilege of producing from start to finish was Abbott Talks. Who knew come season three, I'd go from producer to co host. So thank you to everybody who helps help make this journey happen for me. So, so happy to be here.
[00:01:30] Speaker A: A meteoric rise for sure. And we've sort of introduced our guest. Caitlin, do you want to share with our listeners who's joining us in the booth today?
[00:01:38] Speaker B: Absolutely. So we are so beyond privileged to bring in a pacemaker expert from, of course, Abbott. We have Visharon, divisional Vice president of Product development at Abbott, joining us. We are excited to dig into the world of pacemakers and how they really impact medical device community as well as patients. So Vish will be helping with that.
[00:02:03] Speaker A: And representing the lay people will be Kayleen and myself. So my broad understanding of pacemakers, I mean, we'll get into the details of what they do and how they work, but I mean, for me, they're really sort of the foundational product of the medical device industry. It seems to me, at least looking back, if you Google what was the first medical device, they take you back to the stone age of like, which I don't think really would, would get FDA approval, but, but we can go to pacemakers around the 50s. And, and for me, and I, and I've said this on LinkedIn like, you know, you can, you can talk about Facebook and how they've changed the world with blah, blah, blah, if, if you. Some, if the aliens came down and said, look, we're going to take either Facebook or pacemakers. I bet everyone would say, well, we'll keep the pacemakers. You take Facebook. So, so medtech is the best technology. So I just want that out clear. Kayleen, any thoughts on pacemakers before we get the actual insights from our guest today?
[00:03:01] Speaker B: Yes. So I'm going to take nearly 20 years of medtech reporting and distill it down to this. This is what I know about pacemakers. So people, they require pacemakers to address specific cardiac conditions that disrupt the normal heart rhythm and pumping efficiency. So that could include arrhythmias like bradycardia, where the heart beats too slowly, a heart block, for example, where the electrical signals are delayed or blocked within the heart. And to manage these issues, and those were just a couple of examples, a pacemaker comes in which is a small battery powered device. It's implanted under the skin near the collarbone and then it delivers those electrical impulses to help stimulate those heart contractions in an effort to help maintain a healthy heart rate and rhythm. That's what I understand it as Vish again the expert, I am the layperson. Help educate us. Where did I go wrong? Can you please share with our audience what is a pacemaker? Maybe give us the idea of the history. It's not an axe. We know this, but really the industry as we know it today. When did we start defining a pacemaker as a pacemaker and what did that look like?
[00:04:20] Speaker C: Absolutely. First thing. Tom, it's great to be here with you. It's been a couple of years, but it's always been in touch in various channels. It's nice to be here on the call. Kayleen, really exciting.
I know it's going to be a vibrant conversation that we're going to have today. So we'll get into all the technology.
It's going to be fun. So let's time to dig in.
[00:04:50] Speaker A: How did you come to start working on pacemakers and maybe just briefly connect, remind us about your path into the medical device.
[00:04:58] Speaker C: Yeah, yeah, Tom, you know, it's a long journey. I've been in the industry for about 22 years now, but I grew up in a family of engineers and doctors. I grew up in India and most of them in my family have chosen engineering or medicine to go into. And I was one of the first who brought it together and that was a lot of fun. And I was able to now communicate with both sides of the groups of individuals in my family.
[00:05:28] Speaker A: Are you the youngest child? Are you the peacemaker? That's about the youngest child.
[00:05:32] Speaker C: Peacemaker to make a pacemaker. Yes.
[00:05:37] Speaker B: Trademark. That quick? Someone tried.
So Tom's question sparked a question. So you mentioned medical doctors or MDs and then engineers. I always think the person who connects the two is the linguist of the family. So they're able to speak a special language. So I have a two parter for you. Do you consider yourself the linguist now that you're able to bring those two kind of bit different personalities in the way you communicate together? And then a second question. If you started around 20 years ago, from my understanding there weren't any programs at universities that were really specific to medical engineering or medical technology. How did you piece it together?
[00:06:23] Speaker C: Yes, first thing is I gotta keep the balance between the engineers and the doctors. I'm more of an engineer than a person in medicine. So I don't want to try. I don't try to be too dangerous in the space of medicine, but at least in the area of cardiac health and cardiac disease, I can communicate beyond that. I'd say out of the skis. I'd leave that to my mom who's not a doctor or an engineer to give the best guidance on everything that is possible.
So coming back to the question of education. Started off as a mechanical engineer and that was my background and mechanical engineering did micro electromechanical systems when I came here to UCLA for my masters. And you know, medical technology is all about reliability. It's about providing a solution which is smaller and things you get smaller. It's about especially a pacemaker. Pacemaker, as you said, it's one of the early medical devices, but it's also one of the very sophisticated medical devices because it's an implantable electronic device. It's got electronics, it's got a battery, it has mechanical components which are electrodes and wires. Back in the day they're wires and today we have gone away from wires or what we call leads. And then you have the system on how it communicates to the outside world through either a phone or through other Bluetooth technology and gets into the cloud. So you're talking about a lot of information, a lot of data. So it really stimulates all types of engineering. I joke that it is one of the most sophisticated medical devices because you got to get engineers to talk from disciplines electrical, mechanical, software, communication. And you know, engineers don't like talking too much. They like staying in their lane.
That's actually one of one of my primary roles is how do you bring them together to solve a problem?
[00:08:34] Speaker A: What are the design challenges for pacemakers? You're always I'm sure trying to make them smaller. I'm sure battery life power is a big issue.
Obviously, getting rid of the wires reduces a lot of complexities. But what are some of the hurdles that you clear when you're improving upon this device?
[00:08:50] Speaker C: Yeah, you covered many of them already. And back in the day, which is about 60 years ago, is when we had the first spacemaker. I'm trying to find it. Yeah. Actually, I have a replica right behind you.
[00:09:04] Speaker B: Show and tell.
[00:09:05] Speaker C: Yeah, show and tell. This is actually a replica of the first implantable pacemaker. And it was a company which now I'm proud to be part of, Abbott. And it's a company which through the generations, Abbott had acquired. So this is the first generation one. And given it a perspective, this is what a traditional pacemaker looks like, which is brought into a smaller configuration. When you think about it, this is going into your body. And today spacemaker is like this.
[00:09:36] Speaker B: Stop.
[00:09:37] Speaker C: It is a small capsule.
[00:09:40] Speaker A: That's amazing. It's smaller than a AAA battery.
[00:09:43] Speaker C: Yeah, yeah, it's smaller than a AAA battery. And just gives you perspective of it, gives you perspective that you're putting a medical device into your body. And of course, a person who needs a pacemaker does not really want one. They are sick and they have a heart condition and they don't want to be treated like a patient. They want to be normal. They want to live their life again and do the things that they love. It could be very complex things. It could be people like wanting to play golf or tennis, or it could be simple things as, you know what? I just want to do some gardening to keep some peace of mind. And when you have these big devices implanted in your body, like back in the day or even the generations, what are currently implanted in the millions which are currently implanted, that holds you back from living your life.
And not only it's this device, it's a device which goes with a lead wire like this. And you're talking about many complications which we'll get into. And you move to a device which is so tiny, smaller than a AAA battery going directly into your heart provides a significant change to the life of.
[00:11:00] Speaker B: An individual that's very heavy emotionally. What would, from your experience and understanding, what do patients feel before the pacemaker implant and how do they feel after?
[00:11:14] Speaker C: Yeah. So a pacemaker is generally implanted when you have some type of cardiac disease which is specific to the rhythm of the heart. And the heart needs to beat at a certain rhythm. And most people, it's about 60 beats per minute. That's about one beat every second. And that allows you to. You have the four chambers in the heart, the upper chambers, two on the upper side and two on the lower side. And with the beating of the heart, the blood gets pushed from one chamber to the next chamber and from the other chambers to other parts of the heart, either to the lungs and to the rest of the body. And this needs to happen in synchrony. This cannot happen out of synchrony, because if it happens out of synchrony, you could have various complications. Some of the complications are slow heart rate. If your heart is beating slower than 60 beats per minute. And sometimes it happens that when you want to exercise, when you need to start walking or running or doing even any stressful activities, your heart's got to get up to, say, about 100 beats per minute. And if you cannot do that, you need to stimulate the heart with an electrical stimulation so you sense whether your heart is not beating accurately and then beat again. You talked about another condition called heart block. Heart block is a condition where now these four chambers of the heart need to communicate with each other. And especially the upper chamber needs to send a signal to the lower chamber of the heart. And if this communication pathway through the electrical conduction system of the heart does not go well, that the bottom chamber is not operating in synchrony or is not beating at the same rate as the upper chamber of the heart. And you could have many complications. And there are situations where you're unable to just do your daily work. You might even faint if your heart stops beating for about three to four seconds. In the medical world, it's called a syncope. And that you could faint or you could blackout. And then, you know, if you're driving a car, that's never a good thing. Or if you're doing any activities, which driving a car or even operating a machine is never a good thing if you're going to faint. And you physicians, of course, a patient will then feel a symptom of that and go to their doctors. And the doctors would do the appropriate heart studies or the ECG studies to then decide what type of treatment do they need to provide. And for all these slow heartbeats or irregular heartbeats or inconsistent heartbeats, they decide that whether they need to implant a pacemaker or not, and they end up with that choice.
[00:14:04] Speaker B: So it sounds like it's a personal impact, but then also an impact on your environment, the safety of others, even citing, you know, driving a car, operating heavy machinery. And I also get the sense that there's this, you know, these physical feelings if your heart isn't working appropriately.
Fatigue, I have to imagine, has to be huge. So disruption in your health and your family life, again, the environment around you, once the pacemaker is implanted, how does that improve the life of the patient? What could they look forward to?
[00:14:39] Speaker C: Yeah, typically, after you implant a pacemaker, the pacemaker is a sophisticated electronic device which is sensing when your heart is beating incorrectly in the upper and the lower chamber of the heart. And depending on what your situation is, you could then stimulate or electrically pace. That's the word. Pacing comes in, where you stimulate the heart to activate it again. And the hearts are really, I'd say it's a cool device. It's a cool muscle. At the end of the day, it's a muscle, but it's one. It's such a cool organ that if you give it an electrical stimulation, the electrical stimulation can propagate inside the heart, then creates a mechanical contraction, and that's where is the coolness about. So, I mean, the body is amazing, right? And yeah, sometimes your body does need some help as you age or you have other diseases or you have other genetic issues.
That's what a pacemaker does.
[00:15:45] Speaker B: So does this. If I can just continue kind of the chain of thought here. So what can the patient expect?
Feeling wise? You know, are they more energy? More. Can you kind of help us with that idea?
[00:16:02] Speaker C: I mean, if a person, like I said, you could black out or get a syncope, you're fainting. Now, a person with a pacemaker is not going to have that because the heart's going to be beating. So that's number one. Fatigue is another factor. Fatigue is if your heart was beating slowly and now your heart is, say, beating at 30, 40 beats per minute, and now it's beating at 60 beats per minute, you're going to feel a lot better. You can do your regular work. You're not going to be fatigued. You won't have challenges walking up the stairs. You won't have challenges even getting into your bed sometimes, because it could be uneasy. And then you have the other complications of irregular heart rhythm. And when your heart, your upper and your lower chamber is not beating consistently, you just feel like you have butterflies in your stomach all the time. And you feel like.
Some patients who have had this have told me, yeah, I feel weird. Before I had the pacemaker, I would know that my heart is not beating synchronously. And after you get a pacemaker, it starts to do that again. Being back to Normal, and it comes and goes. So they clearly know that it's an irregular heartbeat. And most people would even know when your heart is starting to beat quickly, quivering or fibrillating. You would know that. But most of the time, it'll go away. It can happen if you have five cups of coffee.
[00:17:32] Speaker B: Been there. Yeah.
[00:17:34] Speaker A: Been there too often. But I want to focus on your news at Abbott. But before we get in there, just a quick question for me about the pacemakers. So leadless pacemakers versus traditional help me. I think I understand the difference of that. And if you could just also unpack the sensing abilities of pacemakers, because, again, we treat it as this old device that's been around forever. But I mean, the fact that it can sense these changes in the heart and then apply a treatment right away is really remarkable. Has that sensing capability, technology, change at all? What are the challenges in determining what the heart needs and then delivering that?
[00:18:13] Speaker C: Yeah, it's a very good question. The good thing is sensing in a pacemaker and sensing and then stimulating has been in the traditional pacemakers for probably about 30 to 40 years. It's not new by itself. But what we have challenges, and this is where the designs of the materials, or what we call the electrodes become important, is you're sensing in voltages like millivolts, and what you're piecing is in a voltage of volts. Just to give perspective, A double a battery is 1.5 volts. That's 1.5 volts of energy comes out of a AA battery. Bigger batteries can get about 3 volts, and bigger ones can even go to 9 volts. But you're talking about millivolt sensing. So you got to have a really good sensing circuit with the good electrode design that you are able to sense them at. Think 1 millivolt is 1000 of a volt.
[00:19:15] Speaker A: That's very precise.
[00:19:18] Speaker C: You're doing it in that range. So that's where the sensing and pacing. And the really good thing about. We'll get into this. The aver doctor, the technology that Abbott has, it's the only pacemaker on the market which has two leadless pacemakers, one in the upper chamber and one in the lower chamber of the heart. So you can sense the heart rhythm in both chamber on either chamber of the heart. And if either chamber of the heart is not in synchrony with each other or beating a little bit slowly or beating inappropriately, it could then stimulate the heart with a pacing signal in either chamber. And the really cool thing, which I'll get into is how they communicate with each other. And they don't communicate via Bluetooth.
[00:20:06] Speaker B: That was my first guess.
[00:20:08] Speaker C: No, it's not Bluetooth. If it was Bluetooth that the pacemaker would last a very short amount of time. And these devices get implanted in older people and they need to last long and you don't, you don't want to take them out frequently.
[00:20:25] Speaker B: We're going to take a really quick pause from our conversation with Vish Sharan, Divisional Vice President of Product Development for Abbott, to bring in our episode sponsor, fpt. A huge thank you to FPT for sponsoring this episode of Abbott Talks. Enjoy.
Praveen Tavare, Executive Vice President and Business Head for FPT Americas. Welcome back to the podcast. I'm so excited to see you again.
[00:20:53] Speaker D: Thank you, Keilyen. It's always pleasure to talk to you and thank you for inviting me again.
[00:20:58] Speaker B: Well, I had so much more to ask you, so I'm glad that you found some time and for our audience that's listening in, I had the pleasure of speaking with Praveen last year on our Device Talks weekly podcast. So I put actually that full conversation in the show. Notes. Please take a look. Praveen deep dives into how FPT America supports medical device industry, its capabilities and it's a really great interview, so please check that out. So with that being said, Praveen, just in case we have our audience who doesn't want to stop and check out that interview right now, can you give us a brief reminder of what FPT does for the medical device industry?
[00:21:40] Speaker C: Okay.
[00:21:41] Speaker D: No, thank you, Carolyn. FPT Software is an international company headquartered from Vietnam. It's a $1.3 billion revenue company with 35,000 employees serving customers across 30 countries and we work in different industries. Healthcare is one of the prominent where we have been serving customers across the globe in various areas. We provide digital health platform we have built for various customers. We have also built software for med device, on device and off device. We have also built software solutions for healthcare providers. So we have our own EMR EHR that runs in 240 plus hospitals in Vietnam and Southeast Asia.
[00:22:28] Speaker B: I wasn't exaggerating when I told our audience that you had a rich history of partnerships in the medical device industry and that your capabilities are quite robust. So thank you for that summary. I was reflecting on our conversation last year so I took a look so that I would be up to date for our conversation today. And Praveen, you said a phrase that has just stuck in my mind. You said that FPT's approach is small enough to care and big enough to dare. Would you mind elaborating on that philosophy?
[00:23:03] Speaker D: Absolutely, Kalinda. We use that because we are very small compared to the big players, but we are very flexible, very nimble, humble, hungry. So that's why we say small enough to care.
People have access not just to me, but to also my boss, CEO of North America. So that's the important part when I say big enough to dare. We have done very complex projects when it comes to MedTech, whether it is applying AI to do the cancer detection, from CT scan to tumor detection on ultrasound, or building a software for hematology devices, urine analysis devices, building a platform for MedTech company. These are very complex projects. So that's why I use we are small enough to care, big enough today just to give you another one from us. I always say small is a new big and trust is a new competitive advantage. And that's what we bring to the table.
We are small, but we are very, very niche, very focused. And when I say trust is a new competitive advantage is because we ensure delivery certainty to our customer.
[00:24:16] Speaker B: This feels like a good place to pause my interview with Praveen Tavare, executive vice president and business head for FPT Americas. But don't worry, we're going to hear from Praveen a little later on in the podcast. But for now, to find out more about FPT, visit their
[email protected] Once again, that's FPTSoftware.com and now we bring you our interview with Vis. Sharon Divisional, vice president of product development for Abbott.
[00:24:46] Speaker A: I think we've teased people long enough, so let's talk a bit more about the event.
[00:24:51] Speaker C: Let's go.
[00:24:52] Speaker A: So is this the conduction system pacing that you're referencing? And tell us a bit about. Let's find out how they talk to each other because this is.
[00:24:59] Speaker C: Yeah, let's get into it. So first things first, as a leaderless pacemaker, talk to you about what a pacemaker is and what a lead is. So a pacemaker sits in your upper chest, typically under the skin or in the muscles under your skin in your upper chest. And you have a lead wire which is. Think of it as a sophisticated. It's a medical device. It's flexible, as you can see over here. Hope your audience can also see some of this in the show and tell.
[00:25:29] Speaker A: We'll show some pictures, folks. Just picture a wire in your head that's coiled around and you've got all the imagery you need.
[00:25:36] Speaker C: That's Right. And this wire, or what we call lead in our industry, gets implanted and gets screwed into the heart, it goes into the veins in your body, and then gets screwed in your heart. And then it comes out and connects to this pacemaker.
And this has generally been the technology for over 50 to 60 years. I talked to you about where this was. From the first generation pacemakers to the newer one, they become smaller, added more features, added sensing capability, as you mentioned tomorrow, and of course, longer, better battery life and communication to the outside world. So many technologies in the traditional pacemakers have evolved, but they have their challenges. And the challenges are, the first thing is that this device, which is a pacemaker, gets implanted in your chest, and that's a surgery. You're cutting open a big slot in your chest and putting in a pacemaker this. This big into there. And then you have these lead wires which go from that slot in the chest into your veins and into the heart. And these lead wires can get infected over time. They can break over time. I mean, we're good engineers, but we cannot design an indestructible system.
And we have tried. We have tried this for many, many decades, and we have improved the reliability of leads over these decades. But still, it's never going to be indestructible because the body is a very rough place to put any device in. You're putting a device which is electronic. You're putting a device which is. You have. It needs to be soft enough that you don't damage other parts of the body. It needs to be robust enough that it lasts so long. And also your body has a lot of blood. Blood is going to erode into these medical devices. And so you got to make sure they're biocompatible. So you have risks of infection. You have risks of breaking of these lead wires in your body. You have complications that even if you're just a passenger in the car and you got. Or a driver in the car, depending on which side of the world you're on, you have your seatbelt over your pacemaker, and if you have a small accident, these wires can break under the seat belt of your car. Or if you're playing volleyball or golf or tennis or pickleball, which is the latest fab. Right?
[00:28:16] Speaker B: So true.
[00:28:17] Speaker C: Yeah, you're playing pickleball, you're gonna have a lot of arm motion. And sometimes you could have a left or a right pacemaker. And when you have these, these leads are getting yanked on, or these pacemaker cans have some degree of damage, and you have to keep having surgery and either replace them or put in new leads. So it's a tough process. Implanting a pacemaker for the first time, I wouldn't say is easy, but it is predictable. But managing a lead complication and managing a situation with infection, which happens somewhere, say about 5% of the cases, maybe even up to 10% of the cases, is very strenuous, or if you have to take out a lead, because if it's infected completely, that's even more challenging situation. So that's where Abbott has developed multiple leadless pacemakers. Along the way. And especially in the past two, three years, we have one which first we developed a pacemaker which goes into the lower chamber of the heart and that senses and stimulates the lower chamber of the heart. And then in 2023, about middle of 2023 and over last year, we've been ramping this up. We developed a pacemaker which has now two devices, one in the upper chamber of the heart and one in the lower chamber of the heart. And these get fixated in both chambers of the heart, and then they can sense and stimulate and communicate with each other.
[00:29:56] Speaker B: So how do they communicate with each other? I'm at the edge of my seat.
[00:29:59] Speaker C: Edge of your seat, that's right. So the technology is called eye to eye implanto implant communication and it's proprietary to Abbott. But what I can tell you is this is not. This has been published in clinical publications by Physicians and by Abbott is we are sending small electrical impulses from one device to the other device. And you send them. Think of them as on and off signals, just like bits. And you're sending, sending them. So you're transmitting electrical signals. The good thing is a heart is a conductive conductive medium or it's a conductive muscle. Whether it is through the heart muscle or through the blood, both of these are conductive. Now, the other device can sense these electrical signals and then can read them. Because we have the algorithms and the other device to read this signal and think of them as just on and off, on and off signals. And they're done at a certain frequency and cadence that we're able, the other device is able to understand. And then can say, hey, the upper device stimulated at this time. So the lower device wait about X amount of milliseconds, which is maybe about 100 milliseconds or even shorter. And then you stimulate in the lower chamber of the heart and that is how they communicate. So it is through this eye to eye technology, which is electrical impulses which are stimulated from either device. Both devices can communicate with each other. They go through the heart and read by the other device, and then the algorithms in the other device through the electronics, understand it and take the right action.
[00:31:44] Speaker A: So are you improving the treatment of patients who are already able to get pacemakers, or are you making. Is this a device that is able to provide treatment for people who previously weren't aided by pacemakers?
[00:31:58] Speaker C: Yeah, that's a good question. It all depends on what the situation is for the person who needs a pacemaker. Now, of course, if it's a patient who a physician is trained and they see a person who needs a pacemaker, they will decide whether they need to give them a leadless pacemaker, and they will decide whether they need to make a decision to give an averred br leadless pacemaker, which is from Abbott, which is these two devices. You could decide whether you want to only stimulate the bottom chamber of the heart. Sense and stimulate. Generally, when I mean stimulate, is sense and stimulate the bottom chamber of the heart, or you need to do only the upper chamber of the heart, or we need to do both and maintain synchrony. And that is where the benefits of the Abbott system, it's upgradable. You could start with one. You could start with a device in the upper chamber. And if the disease or the state of the heart rhythm disorder in the patient changes over time, or the person changes and it's likely to change over time, the physician could then implant the other Abbot aver device into the other chamber of the heart and then automatically get them to communicate, reset the programming, and then they get to communicate and treat the person who needs it.
[00:33:19] Speaker B: I would not have guessed that there'd be modular thinking in pacemakers. That's incredible. What a leap from just a few years ago.
[00:33:28] Speaker C: Yeah, you know, it's always good, right? When we have options. When you have options. Yeah, you got it right. It's modular thinking. It's, you know, think about modular thinking. When you buy things for your house, whether they're electronic devices or your kitchen or pick any of those. Right. But yeah, in a pacemaker, something done before.
[00:33:50] Speaker B: Okay, Vish, if you don't mind indulging me, can we take it even further back? So help me understand, what is conduction system pacing and what does that allow you to do with pacemakers?
[00:34:00] Speaker C: All right, it's a wonderful question. And this is an area which is evolving a lot by the medical community. I would say probably in the more five to 10 years, maybe some activity prior to that, but a lot of action in the past five. Maybe it's really escalated in the past two years. So let me get into that. So talked about the conduction system. I mean, the heart is a conduction system where you're communicating between chambers. But traditionally, pacemakers were placed in the lower chamber of the heart anywhere that they could, or these are the pacemaker leads. I would say, to be more specific, they were placed in the lower chamber of the heart anywhere that a physician thought that it was appropriate and safe. But what folks have realized, and physicians specifically through a lot of research have realized, is there is a more appropriate place to place these electrodes or the stimulation of the pacemaker into a specific part of the heart. And that is conduction system pacing in general. But a more specific part is a left bundle branch area of the heart. And left bundle branch area of the heart is there's a right side and the left side of the heart. There's a right ventricle and the left ventricle, which are both the lower chambers of the heart. The left bundle branch is closer to the left side of the heart. But typically electrodes and leads and leadless pacemakers are placed on the right side of the heart. We don't go into the left side. So the way to achieve conduction system pacing through left bundle branch area pacing is you take the lead or the lead electrode and you penetrate into the wall separating the right side and the left side of the heart. And then you penetrate the electrode in and then you can start stimulating the left side of the heart. And the good thing is when you stimulate the left side of the heart, it gets into the natural conduction pathways of the heart, which then makes the pacing more natural. And it's also called physiologic pacing. So there might many words that the physician community uses, and they use it interchangeably, whether it's physiologic pacing or conduction system pacing, or more specifically, left bundle branch area pacing. So those are how you bring this together. And as I said, this has been evolving very recently and it's really cool. And some of the technology that Abbott is bringing through, some of the clinical evaluation as a leadless pacemaker to now get into what is this conduction system pacing or the left bundle branch area of the heart.
[00:36:51] Speaker B: We're going to take a quick break from our interview with Vish Charon, DVP of Product Development at Abbott, to finish my conversation with PR Tavari, Executive Vice President and business head for FPT Americas Praveen. From our previous conversation, I learned about your rich global presence. How does this geographical diversity impact your talent acquisition, retention strategies and the other aspects of how you support the medical device industry.
[00:37:19] Speaker D: So Khalid, most of the companies have outsourced to India, China, Europe and various other locations. And with all the economic changes that are happening today, analysts also started looking for alternative destination. And Vietnam emerged as most promising outsourcing destination for various reasons. One, the geography is not very tapped. Government is really encouraging talent pool to really focus on the IT services which is helping scale the talent pool. In Vietnam, 65% of the population is less than 35 years of age. So people who are young, very energetic, do not carry any baggage, always willing to learn new stuff, are easily available for the global customers. And lastly, because IT is untapped, there are not many opportunities. FPT as the largest IT company is a brand for many of them to work for. It's a dream company for them to work. So that helps one contain the attrition. And also with young talent, they are very ready to quickly adapt to the changing technological environment. And that is really helping our medtech companies to one, retain the knowledge within the FPT talent pool. And second, we can always explore new technology that is coming into the market, whether it's ChatGPT, Deep Seek or any of the AI. Because people are very, very, very adaptive.
[00:38:59] Speaker B: Oh yeah, so I heard about your most recent acquisition. So how has your near shore acquisition impacted your geographical capacity?
[00:39:08] Speaker D: So Kelly, this was a very strategic acquisition because a couple of things. One is Vietnam though brings a lot of advantage from offshoring perspective.
There was a need for nearshore to augment the onshore kind of a model because there are people in onshore is expensive for some of the projects and customers are not matured enough to, you know, sometimes manage or work in the off hours with the offshore to take care of that. Nearshore really adds a lot of value because those are same time zone. They can interact with the client at the same time in the US time zone and then they can actually manage the offshore. So it brings a blend of bestshore model to our clients. You know, nearshore and offshore together brings a good economic value and a good blend for providing services to our customer. And that added great advantage, especially when it comes to the geographical diversity that.
[00:40:09] Speaker C: We bring to the client.
[00:40:13] Speaker B: Okay, so we talked a little bit about the physical. Let's move into the digital world. So how has the integration of artificial intelligence into your development process changed the way that FPT approaches project timelines and resource allocation?
[00:40:29] Speaker D: So Kalind, in medtech industry What I'm seeing is time is of essence because you know, industry wants to quickly launch their product into the market ahead of time and there are a lot of competition. So we have also from our side looked at various models. How do we quickly deliver the projects to our customers? In the past, I'll give an example. There was a project that we did for 18 months and right now with 125 people, now we have got a similar project from another customers and we are actually using our tool called CodeVista. It's an AI based tool for code generation and this similar kind of projects. We are able to do the project in 30% less timeline and 40% cheaper. And that is bringing quick advantage to our client because it helps one quickly deliver the project and at much better price. Similarly, we had also launched another product called Test Vista and this is also helping quickly not just generate the script, but even when we make small changes into the code and that can be identified. And for regression, which are the code areas that IT impacts, we can quickly generate this text script and do the regression. These are the tools that we have brought to the table which is helping our customers.
[00:41:51] Speaker B: That's how you applied artificial intelligence. On the software development side, have you applied artificial intelligence intelligence on any of the medical technologies themselves?
[00:42:02] Speaker D: Oh yeah. Kalim. We have been using AI for various things right from disease detection. We actually applied AI on CT scan to detect the lung cancer. We have applied AI on ultrasound detecting tumor. We have also applied AI for orthodontists for their symphonometric analysis before, before they actually do the cosmetic surgeries. We have applied AI for fat detection on patients. These are just on the various disease and detection side. But on the IT side also we have applied AI for the EMR analytics. You know, when the patient comes to the doctors and there are a lot of data that most of the hospitals have. Applying AI analytics and handing those information to the doctor, that's another one. AI Scribe is another solution that we have implemented where the conversation between the doctor and the patient are captured and it can be summarized for doctors to at the end of the conversation upload onto the emr. Similarly, we have applied AI for even the nursing solutions, conversational AI which we are building for one of the client. And this basically can help support nurses for pre clinical visit for the patient and post clinical discharge, post clinical follow up, discharge follow up. So those kind of things we have implemented and many more application of AI in the medical industry.
[00:43:34] Speaker B: Well, Praveen, once again we ran out of time so I'm going to have to have you back on the podcast.
[00:43:40] Speaker D: Thank you so much, Karen. Thank you for having me. It was pleasure talking to you.
[00:43:44] Speaker B: Want to learn more about fpt? What got good news for you. The FPT team will be joining us live in person at Device talks Boston, April 30 and May 1. So please come out, meet the FPT team in person, watch their session at the Device Talks Engineering Theater, and if you cannot wait to see them in person, please visit their website
[email protected] Once again, thank you so much to FPT for sponsoring this episode of Abbott Talks. And now we bring you the conclusion of our conversation with Vish Cheran, Divisional Vice President of Product Development for Abbott.
[00:44:23] Speaker A: So what is the appeal of putting the pacemaker in that part of the heart? Does it allow for, does it require maybe less, less stimulation? Is it a more natural way to reset the heart? What's the target? What's the goal?
[00:44:36] Speaker C: Yeah, I would say there are three main reasons why this is better. It is better for the patients long term. And I'll talk to you about a certain situation related to that. It improves the physiologic response in the short term at that moment, it gives you a better physiologic response and it does not. And it prevents future complications like pacing induced cardiomyopathy. Now I'm getting into more medical terms which is a symptom of heart failure. So what can happen is if you are pacing say in the right side of the heart, now the left side is actually the muscle of the heart which is pumping blood to the rest of the body. And that's the big pump. The right side is a smaller pump, the two chambers of the heart. But when you are pacing or stimulating in the right side of the heart, which is the typical location, and if you have a high degree of pacing now, high degree could be 30 to 40% of the time or even higher. You absolutely need basics. Or if you don't have that stimulation, you would feel unwell over time. If you do this excessively and if you are a relatively younger patient over time, you could develop heart failure because you wanted the left side of the heart to be pumping at the right, right rate and there's always a little bit of a delay from the right side to the left side.
So the best way is, you know what, why don't we target to pump the left side of the heart at the right time and that is how you get into this left bundle branch area pacing and get into the natural highway the natural electrical highway of the heart so that you can stimulate that and get the whole heart to pump at about the right time or compress at the right time, which would then pump the blood.
Does that give you. Does that give you a good perspective?
[00:46:31] Speaker B: That's my mind blowing for those who aren't watching this on YouTube. Wow. Wow.
[00:46:37] Speaker C: Yeah, it is. Yeah. You know, nobody. You have a heart rhythm disorder. You don't want to have more complications over time. Right. And a person who gets a pacemaker is. And especially whether you have a lead. Leaded system or a leadless system is going to have your device in your body for a long period of time. You don't want it to create additional harm. And that is where conduction system pacing has really come in. There's a lot of innovations that physicians have done with tools and technology that medical device manufacturers have provided. But it's really the research and science by physicians that this is a better way to stimulate the heart. It's a little trickier. You need different tools. It's not the same tools that they had used in the past.
And that's where it is evolving. And that's where it's fun. It's fun to be an engineer where you're solving new problems in even an old way of pacing.
[00:47:37] Speaker A: When you were developing the Avere, was this a target? Was this an idea that, look, we can go here, then next can go here. And where are you in that process? You're in the middle of a feasibility study right now, right?
[00:47:47] Speaker C: Yeah. So very good question. I mean, Ava, and the leadless technology has been in development for 10 years. So 10 years back, this was really research and maybe a couple of centers in the world and we didn't know where it was going to go. So it wasn't the primary driver of a technology. But the really good thing is there are other features in Avere which position us to do really well. And that is a feature where you have a screw or a helix based fixation. At the end of the leadless pacemaker, you have a screw. And the good thing about a screw is you're more precise. You know where you're going. You're controlling your deployment of the leadless pacemaker in the hard. And that is where this has helped us with moving to where we're going with leadless conduction system pacing. And so that is number one, Number two is a delivery catheter. The delivery of all these, generally all these leadless pacemakers is done from the groin and it is done through a long Tube or think of it, we call them a catheter or delivery catheter, long sophisticated tube which has a pacemaker at the end and has other features that are connected to the pacemaker. And the good thing, what Abbott has in the aware delivery catheter is that it is more maneuverable and bends in various directions and you can rotate.
And as I mentioned earlier, when you were implanting leads into the left bundle area of the heart, they were typically screw based leads or helix based leads. And you would drill them a little bit into the heart muscle, which is called a septal wall and get to the other side or right next to the other side. You wouldn't penetrate into the left chamber but you'd get very close to it. And avere now we had to modify avere to get there Avere dual chamber device of air doctor as it is today doesn't get there. This is why we had to re engineer our leadless pacemaker system to be able to meet this need of conduction system pacing. Because traditionally the older average and the aver doctor system would be placed right on the surface of the heart, not drilled in into the heart. And that is the some of the changes. And of course now that we have a var doctor which has eye to eye, which I talked to you about earlier, the technology where the two devices communicate with each other. Now in the future when we have a leadless conduction system pacemaker, can talk to an atrial system, a device at the upper chamber of the heart and can operate in synchrony with each other.
[00:50:35] Speaker A: Holy moly.
[00:50:36] Speaker B: So that's what's next?
[00:50:38] Speaker C: Yeah, that's what's next.
This is huge.
So our leadless conduction system program, we had a public press release that we were in the journey of doing preclinical clinical evaluations where we did a series of studies and this has been given designated by the FDA as a breakthrough technology.
And the results of this are actually going to be published at HRS HRS is the Heart Rhythm Society meeting which is a conference of mostly all the physicians and the medical device industry. And that is happening in San Diego towards the end of next month. In the late breaking clinical trial session is when you will hear about the final results of this acute evaluation of the leadless conduction system technology.
[00:51:36] Speaker B: Well, definitely congratulations to you and the team.
[00:51:39] Speaker C: Thank you.
[00:51:39] Speaker B: Really exciting.
I have to circle back a little bit before we move on to the patient experience and to better understand, I mean do you have an example or a patient case that you can share how this has Impacted their lives.
[00:51:58] Speaker C: Yeah. You know, I had the privilege of meeting a very special person. This special person was Mikey D. Temple. And we met him last year, and I've had multiple interactions with him since then. And right now, he's 45 years old.
When he was 19, he was a surfer, and he loved surfing. He was actually in New York. He spends time between New York and Southern California. But when he was 19. So think about this. Nearly 25 years back, he was diagnosed with a condition which he required, a pacemaker. And this pacemaker was implanted. It had to be nearly 25 years ago. The only technology were these traditional pacemakers, which had a device up in the chest and lead wires. And over the years, he's had eight surgeries. Over the 26 years, he's had eight surgeries. And he showed it, and we can see it in some of the videos that he has presented, that his upper chest was all cut up, and the surgeries were lead complications, lead dislodgements, either the device requiring replacement. And then when you have all these surgeries, you build up a lot of scar tissue in your body, and you could have many complications about where the pacemaker is implanted. You can't put it on the left, you got to do it on the right. You got to find different locations every time. None of those locations are ideal. And for a young individual like Mikey, who at that time was 19, and it changed his life, he could not be complete. He could not be a professional surfer. And he was a professional surfer, and he's a really creative guy, actually. He's doing a lot of short films right now. So it's the content he's producing and the way he's living his life is really fun. But all this had to stop. And it almost came to an end about a year and a half back, where he had to say, give up. He tried hard. He tried to surf, and he was an individual who was lying. Any surfer, you're lying down on your surfboard and you're right over this pacemaker. You're right over this part of your body, which has had multiple surgeries. It changed his life. He couldn't do that. And he had to come. He had to stop it for the. Avere. Doctor.
Avere. Doctor. Leadless pacemakers, which is this latest pacemaker technology from Abbott, where you have these two pacemakers in either part of the chamber. And he required that he needed to have good synchrony in the upper and lower chamber of the heart. And when he was aware of that and he Was happy to get all this hardware out of his body to go to these small devices in his heart, which are like capsules, right? Capsules. Electronic capsules in his heart. He was so relieved and he could get back to his normal life. Just watching his surfing, watching him spending time between New York and Southern California, it motivates us, it motivates the engineers to go do better, to continue innovating. And that's been a lot of fun.
[00:55:07] Speaker A: That's really.
Anyone who listens to my podcast knows my son is an engineering student that's going to go into engineering and I'm going to make him listen to this podcast. Like, go into medical devices. It's the coolest thing.
[00:55:20] Speaker B: Medtech. Medtech. One of us, One of us.
[00:55:24] Speaker A: So wrapping up, you know, you take that inspiration that you're getting. Where is this space headed? When we celebrate Abbott Talk series six or seven or eight and we have you on. Are you going to be holding up like a battery watch size or is it a AAA battery that can. Can, I don't know, tell time or has all these on the. Like, what is this? Where are we headed?
[00:55:47] Speaker C: Yeah, you know, you know, first, Abbott and CRM does many things right, not just pacemakers, implantable defracort. Many of these are electronic devices for the heart. And developing these and the innovation in this space has been evolving tremendous. Specifically, and I'll go in both perspectives, what's going on with leadless pacemakers? What do we see the vision and also about other technology. So first, about leadless pacemakers. You put in these devices into your body. We need to make them smaller. We need to first. But actually before we make them smaller, we need to get physicians around the world to be trained to use them. This is not a technology that they were trained to in their training through fellowship and other programs. So we as industry have a lot of. We spend a lot of time doing training and we train in the US and it's really cool that this product was first available in the US of all markets in the world. You think technology, sometimes medical technology is available outside the U.S. but this Aware Dr. Technology was available in the U.S. so we have a role and responsibility of training physicians in the US and the rest of the world. The rest of the world has actually come in a little bit behind only because of regulatory reasons, not because of our intent. And that is primary. Outside of that, looking at product technology, we want to make them smaller, we want to make them easier to deliver. We want to make them have even better communication methods that you can Actually talk to the system through Bluetooth and talk to your phone. Today, it doesn't do that. Since it's some of the early technology, we want to get there. And then there's a lot of power to the information and data that can come from these systems.
We also a need to make it easier. At the end of the day, we want to make this leadless pacemaker system which is aware. Dr. And the future technology, really the standard of care for all pacing. And that's hard. I mean, nearly a million pacemakers are implanted and there are people with a million pacemakers today. So making that a standard of care and making this, converting these physicians to use this regularly and all the time. And this is where technology like leadless conduction system pacing is extremely important because physicians want that and that has been growing in the past two to five years. So we want to get there. So that's a future in where we're going at pacing and in everything else. It's about better management of the individual.
We want to treat more diseases. We want to use the power of information and process that through the various tools. You know, you can always say AI with everything that we do. And there's a lot in this world that's fantastic.
[00:58:50] Speaker A: All right. Well, Vish, it's been great to have you back on Avatars and really enjoyed this. The time you gave. This has been a very free flowing conversation and one that I know I've learned a lot from. Kayleen, I trust you did as well.
[00:59:06] Speaker B: Yes. I mean, I loved every second with you, Vish. I think I said before we started recording this episode that I had listened to your first episode in 20, 20, 23 now maybe nine or 10 times because that was when I was producing specifically Avatars and I learned so much then. But now being in the middle of the conversation, be able to ask the questions live as they pop into my head, made me feel even more invested. So thank you for educating me and our audience and for sharing more of your insights and giving me even more hope about the best industry in the world.
[00:59:44] Speaker C: All right, thank you, Tom. Thank you, Kayleen. It's been wonderful to have this conversation and spread the message about medical technology and how much it can change life. As you said, maybe aliens will come and pick this up.
Get rid of Facebook.
[00:59:59] Speaker A: Get out of here.
[01:00:00] Speaker B: Facebook.
[01:00:00] Speaker C: That's right. Who needs their social media?
[01:00:04] Speaker B: You're here.
Thanks so much.
[01:00:06] Speaker A: Thanks, Vish.
All right, well, that is a wrap. Kayleen Brown, great to have you on season three of Apatox. This is A lot of fun.
[01:00:16] Speaker B: I feel like I've made it. This was where I've been trying to go all along. And I'm here when you joined.
[01:00:24] Speaker A: Your anniversary, as you mentioned, is today at Device Talk. So very, very happy to commemorate this day. And I remember when I interviewed you, I said, where do you want to be in two years? And you said, I want to be co host of Abbott Talk. So here you go.
[01:00:35] Speaker B: I did, I did. I had that. I actually have a dream board on the side of my office and it's actually Vish's face. It's just right there in the center. It was like, that's where I want to be.
[01:00:47] Speaker A: Speaking of Vish, what a great guest to have. He's just energy and enthusiasm and insight. Just, he's the whole package.
[01:00:56] Speaker B: What a great representative for Abbott as well. There's this warmth and caring, this patient centric way of thinking. And when he was talking about the patient story, I mean, you can just feel the emotion behind that. That's. I say it to you, Tom, daily. I say it on all of our podcasts. This is the best industry in the world. But the reason it's the best industry in the world are people like Vish.
[01:01:17] Speaker A: Yep.
[01:01:17] Speaker B: I love it.
[01:01:18] Speaker A: And I love that he brought up when he was holding up the new pacemaker versus the old pacemaker, but talking about the complexities of designing devices for the human body and just the fact that you know that when you put one in, like, it's really hard to go in and fix it. Like, you can't just lift the hood and like, oh, yeah, okay, you're all set. Like, you have to know that this device that you made is going to do what you built it to do. That's a tremendous amount of pressure. And hats off to all the biomedical engineers out there who are. Who are making that happen. It's really remarkable, remarkable work.
[01:01:54] Speaker B: Very, very well said. It's the intangibles that don't really think about or, you know, it's not just about that single surgery and a single view of an outcome. It's understanding that this is the first step of a long journey. And in many ways, to have that journey have the best outcome is to limit the number of steps that follow.
So well done. I second you. Well done. To the team and to all those in the medical device industry who think about it that way.
[01:02:22] Speaker A: Awesome. Awesome. All right, well, we'll have another Rabbit talks coming to you in a, in a month or so. And of course, make sure you go to device talks.com to check out all our great events and our great webinars. And what should people be doing to make sure they don't miss a future episode of Abatox?
[01:02:42] Speaker B: Kayleen Brown well, if you would be so kind as to like and follow us. So follow us on every major podcast platform. Apple Podcasts, make sure. Or Spotify. Make sure to follow us on YouTube as well. So Abbot Talk Season 3 is a video podcast. Not only have I moved forward to my dream, but Device Talks and Abbott Talks in particular has evolved from audio only to video. So please check us out on YouTube and follow us on YouTube so you get access to every Abbott Talks as well as every Device Talks podcast. Medtech Stories. Please also follow us on LinkedIn. So I'm Kayleen Brown, the managing editor for Device Talks. Everybody knows Tom Salemi, the editorial director. But do follow us and also please follow our amazing sponsor. We can't create these podcasts without their help, so thank you, thank you. Thank you so much to our sponsor, fpt. We really, really appreciate everything that you've done. We cannot tell these incredible medtech stories without your support.
[01:03:45] Speaker A: So well said. All right, folks, thanks for joining us on this episode of the Abbott Mox podcast.
