Ep9: Using AI to Transform Cardiac Arrhythmia Care, With Vektor Medical

[00:00:00] Henry Peck: Hey everyone, it's Henry. Welcome to Emerging Medtech Today by LSI. Today, I'm joined by Lana and Rob from Vektor Medical. Together, we discuss the challenges in cardiac arrhythmia care today, how Lana and Rob took on their current leadership roles at Vektor Medical, and how Vektor's non invasive AI based solution promises to help physicians understand and treat arrhythmias more effectively, improve patient outcomes, and reduce costs. Enjoy.

[00:00:31] Henry Peck: Rob, Lana, welcome to the Emerging Medtech Today podcast. Thanks so much for joining us.

[00:00:35] Lana Caron: Hey, Henry.

[00:00:37] Rob Krummen: Thanks for having us. Pleasure to be here.

[00:00:39] Henry Peck: Awesome. Lana, would love to start with a brief introduction on yourself and your role at Vector Medical.

[00:00:46] Lana Caron: Yeah. Thanks again for having us really excited and honored to be part of the inaugural season. I recently joined as the Head of Business Development at Vektor Medical. And in terms of my background, [00:01:00] I have over 20 years of experience in venture capital as a venture investor and also operator across a number of early stage startups and established technologies companies.

[00:01:13] Lana Caron: And most recently, I served as senior director at Philips Ventures, the venture capital arm of Philips, where I led partnerships and venture investments focused on data, AI, and digital health across cardiovascular and neurovascular clinical domains. While I was at Philips, I worked very closely with our product teams across many businesses that were looking to address challenges across cardiac care pathways. I worked very closely with our image guided therapy team that focused specifically on the cath lab setting and I got the front row seat [00:02:00] to see, to understand the complexities, the challenges that exist across the cardiac care pathway, but also understand how to leverage digital and AI technologies to solve some of these challenges.

[00:02:14] Lana Caron: We evaluated over 500 companies so I'm pretty confident when I say that I probably got to see the latest and greatest when it comes to AI and digital technology. And over time I started to develop the pattern recognition that VC's often have to help differentiate good from great. So when I met Vektor Medical, I was really impressed by the technology and the team, and I saw the potential in vMap changing and transforming the standard of care and how care can be delivered to patients across the world.

[00:02:54] Henry Peck: Fantastic. And I'm curious, having spent so much time in venture capital and as you [00:03:00] mentioned, getting that savvy for recognizing patterns, seeing the next big thing and sifting the great from the good, what motivated you to want to get back into the operator side in addition to the outstanding technology Vektor has, making that decision to leap from the corporate strategic venture arm back into the early stage company?

[00:03:19] Lana Caron: I've always loved building things and there's nothing better than working with a team that really knows what they are doing. And I'm just really excited to be part of this team in particular in this space that I'm very passionate about transforming the cardiac care and, given the experience that I've had working with many data, AI and digital company, I really felt I can help accelerate the commercialization of this particular technology and accelerate bringing in this value to many clinics and many EP practices that are out there today looking for this kind of non invasive [00:04:00] AI based solution.

[00:04:02] Henry Peck: Makes a lot of sense. And thank you for the overview of the company. I want to give Rob a chance to introduce himself and also ask, now that you've taken on the role of CEO at Vektor Medical, what was it like transitioning into that role from your previous roles at the company?

[00:04:16] Rob Krummen: Yeah, great. Thank you, Henry. Like Lana, I'm very excited to be here and we're looking forward to the opportunity to talk to you and your listeners about the risks associated with heart rhythm disorders, also called arrhythmias, and how Vektor Medical is working to revolutionize arrhythmia care. So I've spent the last 20 years at the intersection of law and business, working with cutting edge science, innovative companies and ideas.

[00:04:41] Rob Krummen: And I was thrilled, I was absolutely thrilled to join the company 5 years ago. Back then I was the Chief Operating Officer and my role was really to drive our clinical and our regulatory product efforts, moving from what was really a proof of concept research software, into a [00:05:00] full what it is today, the US FDA cleared medical device. About 18 months ago, our board of directors at Vektor Medical asked me to transition to the CEO role.

[00:05:10] Rob Krummen: And that was really to build on our early success. So really to ensure that long term promise of improving arrhythmia care, which I'm incredibly delighted to say we're doing on a daily basis around the country. And to get specifically to your question on the perspective of a lawyer CEO, it's interesting, they didn't they did a research, U. S. News and World Report went and looked about 10 years ago into the number of lawyers that are CEOs at companies, and it's about 10%. So it's not the most common background coming into the CEO role.

[00:05:42] Rob Krummen: But interestingly it does arm you with a skill set of taking extremely complex problems or activities and helping break them down into more concrete, achievable activities, whether that's an incredibly complex legal issue or launching a new technology and building a [00:06:00] world class startup team. And let me just give you two examples, if you'll allow me. In Medtech, one of the things that's interesting is there's a number, not a lot, a large number, but a small number of major players that drive cardiology and electrophysiology today. And really in order to play in that sandbox companies need to be smart about protecting their innovation before sharing the ideas.

[00:06:23] Rob Krummen: And so one of the things we did in Vektor Medical was to leverage the brilliant minds we had in the company to establish a strong IP portfolio before we came out of stealth mode and that allows us to play on a more comfortable level with those players. Another area that I think is really interesting is the idea of working in a regulated environment. And that can be intimidating for early entrepreneurs and small companies.

[00:06:47] Rob Krummen: But I've spent my whole life working in regulated environments, and when you have that experience, you realize there's a brain power that exists in our regulators. Some of the sharpest minds I've come across have been at the US. FDA. And so from our early [00:07:00] days at Vektor, we engaged in, and this may be controversial, but we engaged in open communication with FDA. And it helps set our expectations for getting through clearance and actually will help us. We're building AI based enhancements today. And our conversations that are going to help us in the future.

[00:07:18] Rob Krummen: So there's just a couple examples of how the lawyer CEO thinks about building in an entrepreneurial space, but it really helps set those foundations that we need to build. And I'm really proud of what we built. I think we're going to have a real impact on the cardiovascular space and help what we'll talk about in a minute, the many millions of people suffering from cardiac arrhythmias.

[00:07:39] Henry Peck: Absolutely. And it's fascinating to hear about that perspective from the lawyer CEO transition. We had a panel at our last event in the USA with lawyers that were in venture capital. And we heard an interesting, similar thread of how, breaking down those problems with that background provides a different perspective to compliment the other perspectives that are rounded [00:08:00] out on the team, as you hear with with Lana and her venture capital background yourself with your legal and business background.

[00:08:05] Henry Peck: We talk about the problem that you're solving here and cardiac arrhythmia care at large is a massive one. Lana, I'd love to hear from your perspective. Tell me about this problem by the numbers. What's the standard of care look like today and why is this such a compelling area for innovation?

[00:08:22] Lana Caron: The standard of care in cardiac arrhythmias right now is far from optimal. In fact, it hasn't really changed that much in the past two decades. It's, the cardiac arrhythmia care today is probably where the CAD or coronary artery disease care was about 20 years ago. And that's staggering. And when you start looking at the numbers that, they are even, they are shocking. The incidence and prevalence of the diseases on the rise. You've got 1 in 4 adults over the age of 40 that's going [00:09:00] to develop this kind of arrhythmia condition.

[00:09:04] Lana Caron: And if you look at the number of patients that are actually getting treatment, it's really small. Only 2 percent of patients who have been diagnosed with atrial fibrillation, for example, or AFib, which is the most common cardiac arrhythmia condition, are going to get treatment. 2%!

[00:09:25] Lana Caron: So the it's definitely not where we want, right? The standard of care to be and something is going to change. The challenge is that not a lot of people realize that cardiac arrhythmias can cause stroke. And other conditions like dementia, leading to 10 percent of global deaths.

[00:09:48] Lana Caron: So there is a lot of just general public awareness that still needs to happen. And the other challenge is that, given the staff [00:10:00] and clinician shortage across the healthcare systems we just, we can't throw bodies at this problem, right? So we've got a disease, incidence and prevalence on the rise while we have only a small number of patients being treated. So we can't throw clinicians of staff at this problem. We have to look at the technology that can tackle this.

[00:10:25] Henry Peck: And you mentioned, taking a look at that technology that can tackle this, let's expand on that a little bit. And drawing from your background in venture capital and in healthcare, what makes cardiology particularly ripe in addition to the market that size and opportunity? What about this space makes it ripe for those technology solutions, the integration of AI and other digital technologies to improve the existing standard of patient care?

[00:10:50] Lana Caron: Let's break this down a little bit more. Over the past five years I spent while at Philips, I spent quite a bit of my time working with some of the [00:11:00] brilliant minds in healthcare and technology from clinicians to scientists and engineers, breaking down these problems, breaking down these challenges, looking at complex care pathways like neurovascular care pathway and cardiac arrhythmia pathway, trying to better understand where the bottlenecks are, right? What the current workflow looks like, and how to potentially optimize it.

[00:11:27] Lana Caron: And what I learned was that, if you look at the neurovascular care pathway, for example or stroke care pathway, the challenges that you see across that care pathway are very similar challenges that exist today across the cardiac arrhythmia pathway. These pathways are incredibly complex. They are lengthy with lots of touch points and handoffs. Many stakeholders, and it [00:12:00] takes a really long time to diagnose a disease. And then it takes a really long time to get the right treatment to the right patient.

[00:12:08] Lana Caron: So when you look at these kind of problem and you started thinking about what can be done, right? Given that we can't really throw bodies of this problem. You started thinking about AI and digital technologies and how they can automate some of the steps and some of the inefficiencies that currently exist today with a goal to treat early or diagnose somebody early and bring them to the right treatment, to the right treatment facility to deliver care that they need, thus enabling and expanding the care to many more patients.

[00:12:50] Henry Peck: Yeah, the opportunity there is tremendous, particularly with the advancement of the technologies you're referencing. Let's now put it in the [00:13:00] context of Vektor Medical. Rob, talk me through your solution, what it is, how it works, and give us an overview of your clinical studies, particularly the exciting data you recently presented at a symposium on biomarkers and personalized medicine in cardiovascular disease, and on this exciting utility of the product in unmappable ventricular tachycardia ablation.

[00:13:24] Rob Krummen: Yeah, thanks, Henry. And I would just want to say, I think Lana speaks very eloquently on the problem. It's a huge problem. It's behind some of the other areas in cardiology, and it's really ripe for a technological solution like our product. vMap really looked at what's missing in cardiac arrhythmia care and intends to step into that void.

[00:13:45] Rob Krummen: What vMap is, it's an AI based arrhythmia analysis tool, and it's really intended to hit at the heart of some of these problems, cardiac completion outcomes, improved workflows and procedural efficiencies. And so how do we do that? What we do is [00:14:00] first, we're the only noninvasive arrhythmia tool on the market today that uses data just from the 12 lead ECG.

[00:14:07] Rob Krummen: And the reason the 12 lead ECG is so important as our tool is it's the most used test in cardiology. It's available around the world. You can get one from your general practitioner. You can get one from your cardiologist. You can get one from your electrophysiologist. But at each stage, if we're able to capture your arrhythmia at any of those places along the care pathway, I can help your electrophysiologist help you. And that's incredibly important.

[00:14:34] Rob Krummen: What we're intended to do, what we do, is we help improve patient outcomes and simplify the procedures. By helping the physician understand your specific arrhythmia. And so those are our value drivers: improve patient outcomes, enhance procedural efficiencies. Now, it should be intuitive, but let me give you a little bit more background.

[00:14:52] Rob Krummen: What we do is we have a vast computational and clinical based library of arrhythmias. [00:15:00] Over a million actually. And we take, and in that, we're able to understand where your arrhythmia is located. And that's important if you understand an ablation treatment, because ablation is essentially treating, burning, freezing, or otherwise taking care of the area of your heart that's causing these irregular heartbeats.

[00:15:20] Rob Krummen: And the amazing part about our bodies is, and I love this about it, the ingenuity of our bodies is, if you treat these malfunctioning cells in your heart that are causing these irregular beats, your heart returns to healthy function, love dub. And it's absolutely amazing, we go back to healthy state if we treat the right areas. So it should be intuitive, therefore, if I can help the doctor reach those areas, we can get better outcomes.

[00:15:45] Rob Krummen: But also, if you know where you're going ahead of the procedure, you better plan your procedure. You do less un-targeted activities in the procedure. And so that leads to a shorter procedure, which has a lot of benefits. If we talk about health care economics, we're talking about reducing cost. [00:16:00] But also enhancing patient safety, less time on anesthesia, less exposed to Xray or fluoroscopy. And we're seeing some of those benefits every day with the clinicians that are using our technology.

[00:16:12] Rob Krummen: So you asked about some of our recent studies. One of those is we did a time study, looked at the first 30 cases of our, the use of our product. So it wasn't biased. We just took the first 30 commercial cases and we compared them based on arrhythmia type, based on complexity type, and actually the doctor, so I think there's six or seven physician electrophysiologists involved in the study. And what we saw is actually compelling and incredible data compared to the use with vMap and prior to vMap we saw 26% reduction in procedure time.

[00:16:48] Rob Krummen: Now, keep in mind. Some of these procedures are 2, 3 or 4 hours long. If you have an incredibly complex V. T. and I can pull an hour out of that procedure, that's an open operating lab that can help another patient [00:17:00] or let's be honest, nurses work incredibly hard. And if they can get home a little bit earlier or just not have burnout, which we're seeing in our hospitals, that's an incredible benefit to the health care system.

[00:17:10] Rob Krummen: Let's talk about the other two studies that you mentioned, the biomarker study. That's one of the ones I'm most proud of. At the biomarker symposium this year, we talked about our early study data with atrial fibrillation, which Lana mentioned is the most common type of arrhythmia.

[00:17:25] Rob Krummen: In those cases, when compared to a PVI only standard of care, we're able to see a 51% increase in successful freedom from atrial arrhythmias at six months. That's outstanding. That's a monumental jump. I wouldn't be so excited if we were talking a 10 percent increase or, a marginal increase with some procedural efficiencies. These are real patients with real improved outcomes.

[00:17:50] Rob Krummen: The other study that we talked about, and this is on the total opposite spectrum, we have the most common cases, now we have the most difficult cases. You talked about unmappable VTs. [00:18:00] These arrhythmias in the bottom of your heart. And they're called unmappable because doctors hate doing them. In order to essentially entrap and find the location source of these arrhythmias, they have to induce your arrhythmia and essentially puts you in a state of no blood pressure. So you, for lack of a better terminology, you essentially die for a short amount of time, and the doctor has to bring you back to life. And this can happen several times, which is why electrophysiologists don't like to do it.

[00:18:27] Rob Krummen: The neat part about our technology is that we can give the physician guidance on where to head, and then treat it without this multiple opportunities of killing you and bringing you back to life. Really improving, decreasing risk, but we also saw an incredible 98% reduction in ICD therapy with the use of our technology in these cases. We announced that at H. R. S. back in May, incredibly excited about it.

[00:18:53] Rob Krummen: In total, we set out with this technology, to create a product that enhances [00:19:00] outcomes, safety, costs and efficiencies. And we're excited that all of our early data is hitting on those points.

[00:19:07] Henry Peck: That's fantastic to hear. I think the perspective of taking, both the most common scalable condition within the disease state, as well as the most challenging, heady beasts that you have to face is fantastic to see, especially at this stage. And as you mentioned, the product is clearly doing what what you intended in that FDA has given it the nod and it's now on market. I'd love to hear where the company goes from here with that approval and a commercialization pathway being developed now.

[00:19:36] Rob Krummen: Yeah. Great question. So that's really my job. That's Lana's job. And really our job is to build on these early successes. And play out the long term vision for the company. So really, there's three piers for that. So first, we have to build that foundation for strong growth and execute on our commercial rollout.

[00:19:54] Rob Krummen: The second is continuing to generate strong clinical evidence. Doctors care about the clinical evidence. [00:20:00] Electrophysiologists feed on that information. And that is the lifeblood of Medtech. And the third thing is continuing to innovate. We're already working on additional AI enhancements for our technology, because the science requires it, the doctors require it. And we're also moving towards a cloud based infrastructure.

[00:20:17] Rob Krummen: And that's important because today in the U. S. market, we have a hardware system. It works well in the U. S. market. In other places, it may be better to access and provide distribution through a cloud based system where you get on a web browser, you enter the patient's information, and then we provide that data back, without needing to provide a computer system in potentially remote areas or clinics that need to move around.

[00:20:43] Rob Krummen: A little bit more detail on each of those areas. In the foundation sid, and L ana has been instrumental on this, I can't give her enough credit for her work, but we're building a world class medical advisory board with real key opinion leaders from around electrophysiology. Just some incredible names, and we're going to [00:21:00] work with these experts to build out further evidence in atrial fibrillation, VT, and then excitingly, I don't know that we've ever mentioned this before, but our technology also has utility and we're starting to develop this in CRM. Which is an incredible market. More people get pacemakers today than get ablations. And we see an opportunity to be in that field as well. Because we can map pacing which is a phenomenal.

[00:21:24] Henry Peck: If you don't mind me asking, how did that opportunity come up? Is that one that came from outside of routine clinical use from KOLs? Is that something that came from internal R& D? What was the process of discovering that additional utility?

[00:21:38] Rob Krummen: I love the question, Henry. It really actually came internally through innovation of our own R& D team. We realized that we could map pacing. And what was some of these tools but pacing in another format. If you think of a pacemaker, if you think of CRT therapy, each of those leads is like pacing for an ablation case.

[00:21:56] Rob Krummen: And so if I can map an arrhythmia, it's even easier to [00:22:00] map a pace, a pace lead. And so getting, one of the interesting things is, there's some theories that almost all implantable devices are implanted sub optimally. And if you can give people an easy and cost effective tool to give a better, more effective heartbeat, you may improve a lot of life. So we're really excited, that's in early days, but we're really excited to work on that, that tranche of our technology.

[00:22:23] Rob Krummen: Some of the other areas that will continue to work on, yeah, I think we're really excited about it. Some of the other areas, we want to continue to build that clinical evidence, we want to strengthen our commercial team. We also want to make sure that we're, we have easy integration and all mapping systems in the US market. I mentioned earlier, there's some major players in the US market. Each of them have different customer bases.

[00:22:44] Rob Krummen: The neat part about our complementary technology is that we enhance all of those technologies whether you're working with a player like Biosense Webster or J& J, we can help those cases and we don't need to, we don't need to displace anybody. But we get [00:23:00] everybody a better outcome, a quicker outcome. And, that makes industry better. That makes patients happier. And that makes doctors happier.

[00:23:06] Rob Krummen: The last thing is, I mentioned it earlier, and it's really important. We've launched some significant enhancements to our technology. We'll be announcing that actually in a PR release in the next few weeks. It's, in all ways, it's a newer and more a doctor friendly version of vMap and some of our early doctors are already using it with fantastic feedback. And then we're actively developing those proof of concept AI enhancements. We're jumping in a little bit into imaging analysis and some other stuff that, that is, in a major part of the cardiovascular care pathway.

[00:23:43] Henry Peck: Very interesting. And these are the kinds of updates we'll be looking forward to at LSI Europe 23 in Barcelona, Spain, where you'll be presenting Vektor Medical and hopefully able to share as much as we can possibly get our hands on about these exciting new applications and utilities of the technology. Lana, before I ask Rob about [00:24:00] his first time at LSI Europe, I'd love to hear your perspective from having attended LSI previously, what are you looking forward to on behalf of bringing Vektor Medical there for the first time?

[00:24:10] Lana Caron: First of all, I'm a big fan of LSI. I've attended many LSI events and spoke at a number of them. And what I love what you guys have created and built is the community that you bring together from startups to investors to strategics. And I also really enjoy the size of the community. It's not too small, it's not too large, just the right size that creates that intimacy and creates connections that truly lasts.

[00:24:48] Lana Caron: But it also, just speaking from experience, it also helps us on the startup side find the connections that we need within the venture world. And on the VC [00:25:00] side, coming again from the Phillips venture world, we during the 2020, I believe it was 2021 and 2022 I forget now, but we actually found a number of syndicate partners for three deals that we were working on at that time. From my perspective it's a really great proof point for LSI and the community and that you've created because it really enables us innovators and investors to do what we are here to do. To bring the innovations to the people that truly need it and can benefit from them.

[00:25:43] Rob Krummen: Yeah, and I want to add, I'm incredibly excited about LSI Europe. It's an impressive list of innovators, industry and investors. And we've been proactive in scheduling meetings. We already have a number of one on one meetings scheduled and that are in general, a benefit to the [00:26:00] dialogue that happens between industry and inventors.

[00:26:03] Rob Krummen: And we're also incredibly excited about talking about Vektor medical outside of the United States. We have a really strong early traction in the US, but attaining CE mark is one of our goals for the company over the next 24 months. And given our understanding of the differences between the US market and the European market, and particularly how each does ablation procedures a little bit differently and the tools that they analyze.

[00:26:26] Rob Krummen: We see a real opportunity to, in the future, to assist in the European market. And, that's one of those discussions that's so nice to have, those relationships that are so important to build for our future to talk with the innovators, and the industry, and the investors in Europe.

[00:26:44] Henry Peck: Awesome. We are very excited to have both of you there and appreciate the perspective on the success you found in the events previously, Lana and Rob. Looking forward to hearing more about how Vektor Medical will be able to penetrate the European market.

[00:26:57] Henry Peck: I'm sure there's going to be a lot of interesting [00:27:00] discussion about the differences in dynamics with the regulatory changes between the EU and the US, and I'm sure there will be some interesting perspective to add from Vektor, already having FDA clearance and now pursuing the European market via CE mark. So really looking forward to that amongst the other technology and clinical updates and business updates that you'll be providing there. Thank you both so much for joining us today. And we'll see you in Spain.

[00:27:23] Rob Krummen: Thank you very much, Henry.

[00:27:25] Lana Caron: Thank you, Henry.