Brad Wilson: Hi everyone, welcome to Market Watch. I'm Brad Wilson, and I'm really pleased today to be joined by Vish Charan from Abbott. Vish, could you introduce yourself to the audience, please?

Vish Charan: Absolutely, Brad. I am the Divisional Vice President of Product Development and Clinical for Abbott Cardiac Rhythm Management. It is great to be here at the Heart Rhythm Society (HRS) conference in Chicago.

Brad Wilson: Pleased to have you. I think today we want to talk a little bit about pacing. Let's wind back first of all and talk about the evolution of pacing. If we roll back 10 or 15 years, how would you describe the journey so far and where we’re at today?

Vish Charan: Brad, 10 to 15 years ago, pacing was relatively stagnant; the focus was largely on defibrillation and heart failure management rather than traditional pacing for bradycardia. Recently, this has changed due to physician innovation in conduction system pacing and industry breakthroughs in leadless pacing, which eliminate the need for traditional leads. It is an exciting time to see this innovation after the field has existed for over 60 years.

Brad Wilson: So, if we move on a little bit, we’re at leadless now. How has leadless pacing really evolved beyond just addressing complications?

Vish Charan: Leadless pacing involves a small capsule with an integrated battery placed directly in the heart via the leg. For the past decade, it has primarily been used to eliminate complications related to leads and pockets, but it was limited to the ventricle. Today, Abbott offers the Aveir DR system, which allows for synchronous sensing and pacing in both the atrium and the ventricle, providing a no-compromise solution for physicians.

Brad Wilson: How significant is this moment in the field? What does this technology really unlock?

Vish Charan: It's about combining leadless solutions with conduction system pacing. Conduction system pacing allows physicians to place leads in specific areas, like the left bundle branch, to pace the heart more physiologically and avoid pacing-induced cardiomyopathy caused by traditional apical leads. We are now bringing these two worlds together. At this conference, Dr. Vivek Reddy presented results from a clinical trial showing how the industry is moving toward combining leadless technology with conduction system pacing.

Brad Wilson: You mentioned the data. We saw some data a few weeks back at EHRA, and we’re here at HRS now. What has stood out from the latest data sets?

Vish Charan: In the last 10 days, between Paris and Chicago, we’ve had three major late-breaking clinical trials. At EHRA, we shared real-world evidence showing that leadless atrial devices have a lower complication rate and a better safety profile than conventional leaded systems. Specifically, we saw a 50% to 60% reduction in complications over a one-year follow-up.

Today at HRS, we had two more presentations. One was a pivotal trial for a novel, true bipolar ICD lead designed for conduction system pacing in the left bundle branch area. This lead serves the critical need for defibrillation while providing physiologic pacing. Dr. Rob Schaller presented these data, which showed high safety and efficacy.

Brad Wilson: And what about the "holy grail" of pacing you mentioned?

Vish Charan: Dr. Vivek Reddy presented an early first-in-human study on a modified Aveir system designed to be placed in the left bundle branch area to provide leadless conduction system pacing. This is what many call the holy grail of pacing, as it brings together the benefits of both technologies.

Brad Wilson: If we look at these data, what meaningful changes will they have in clinical day-to-day decision-making and practice?

Vish Charan: It is essential to provide credible data that physicians can trust, whether from industry trials or real-world evidence. Abbott also sponsors many educational events to train physicians on these new tools and technologies so they can effectively evolve their clinical practice.

Brad Wilson: Let’s talk a little bit about the future. What is on the horizon that you're most excited about?

Vish Charan: Over the next three to five years, pacing will become more tailored, more physiologic, and significantly more leadless. We will see more hybrid and modular systems designed to meet the specific needs of individuals with heart rhythm disorders. It’s a very exciting time for innovation in this field.

Brad Wilson: Vish, I appreciate your time. Great discussion, and hopefully we can have you on Market Watch again down the line.

Vish Charan: Looking forward to that, Brad. Thank you.