The new frontier: Interventional cardiology and technology

by Jeffrey M. Schussler, MD, FSCAI

SAN DIEGO — The opening lectures at the Society for Cardiovascular Angiography and Interventions Scientific Sessions, given by Christian Assad-Kottner, MD, and Peter J. Fitzgerald, MD, PhD, felt more like TED Talks than a plenary session. This set the tone for SCAI 2015 in San Diego.

Dr. Assad-Kottner started by making the point that it is getting harder to separate our technologies in the cath lab from the technologies that we are using outside the cath lab, and the overlap of these two is becoming more apparent.

Networking

“It used to be that you came to meetings to network, but no longer,” Dr. Assad-Kottner said. You can only talk to a few (maybe a few hundred) people when you physically show up at a meeting. With social networks, you can simultaneously network with and be networked with thousands or more, instantly. Social networks, which he suggested should be called "information" networks, are priceless and allow for wide dispersal of information both to physicians and patients.

Rapid technological advancements

New technologies such as IBM’s Watson may actually help us think better. Computer systems, filled with huge banks of knowledge, allow for vast integration of diagnoses and help with diagnostic algorithms.

Jeffrey M. Schussler

Apple is getting into the medical field with its new focus on personalized medicine, wearable devices and software (HealthKit) that allow design of applications for individuals.

Google Glass: There is a huge explosion of new devices that allow for creation of augmented reality, using both real and computer-generated imagery, which (at least in a cath lab setting) allow for the presentation of virtually created imagery in your field of view.

Virtual reality in the cath lab

In 2 years, you may wear a pair of smart glasses (ODG, VitalMedicals) that allow you to see point-of-view streaming images, keeping angiograms in your field of view, in addition to supplemental integrated images. For instance, you can have your own personal "screen" on which data can be projected to help guide interventions, valve placement, and so on.

Teaching and training others to perform procedures, and its impact on medical education, may be the most exciting area in which virtual reality may be employed. Actually experiencing what happens during a procedure from the operator's point of view allows a level of depth of experience that simple case presentation cannot convey.

Disruptive technologies

Dr. Fitzgerald talked about disruptive technologies, which may include creating new heart cells from de-differentiated epithelial cells, which may allow for personalized cardiac medication, tested on an individual’s cardiac structure. Genotyping may pave the way for individualized treatment programs based on individual genetic variability.

Noninvasive evaluation of a coronary tree using CT coronary angiography is now allowing both anatomic as well as physiologic (using CT fractional flow reserve) evaluation before a patient even gets to the cath lab.

Robotic and artificial intelligence technology, such as that used to drive cars without drivers, will move into our arena and will standardize the variability of our treatment strategies. Placement of a stent without wearing lead, without radiation and with less contrast for the patient will be available to us in the near future.

Haptic force-feedback will soon be available to help with placement of transcatheter valves, and with other structural heart disease treatments.

Once again, personalized technologies (the so-called "wearables") were introduced at the 2015 Consumer Electronics Show, allowing new personal diagnostic capabilities that will be put into the hands of consumers. For example, congestive HF patients may be soon wearing or have implanted devices that can monitor the patient at home and prevent readmission rates, reducing deviations from expected parameters that would otherwise only be checked intermittently.

The biggest shift may be in point of care or consumer care, which will be administered (both diagnostics as well as therapeutics) in new venues that are not traditionally thought of as health care sites. There will be an "Uberization of medicine," which will be brought to the patients, rather than have the patients go to it.

The current era allows for very rapid-cycle changes, unheard of dispersal of information (in real-time or near real-time) and will lead to new advancements in our field. This will also be a disruptive time in medicine in general and cardiology specifically. It is happening — whether we like it or not — and we all need to learn about these technologies that are being brought to market and will likely have a direct impact on our patients and our practice of interventional cardiology.

What impact do you think new technologies will have in interventional cardiology? Could virtual reality have a place in your cath lab? Let us know your thoughts on this Eye on Intervention blog by submitted a comment.

Jeffrey M. Schussler, MD, FSCAI, is attending SCAI 2015 Scientific Sessions this week. He is an interventional cardiologist at Baylor University Medical Center in Dallas.

Disclosure: Schussler reports no relevant financial disclosures.