Learn how Medtronic is moving to mark the Arctic Front family of cardiac cryoablation catheters as a first line treatment for atrial fibrillation

August 4, 2021

In this episode, Rebecca Seidel, president of cardiac ablation solutions, and Dr. Robert Kowal, vice president, medical affairs and CMO of cardiac rhythm and heart failure, detail how Medtronic is targeting atrial fibrillation, a deadly and far-ranging disease, with the Arctic Front family of Cardiac Cryoablation Catheters , a delivery of cryoablation therapies. FDA approved the Medtronic Arctic Front family of Cardiac Cryoablation catheters for initial treatment for people with atrial fibrillation. Medtronic is moving forward with a unique direct-to-consumer approach and bringing insurance companies in on the conversation. The conversation also hits upon the company’s emerging pulse field ablation therapy.

 

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Tom Salemi (00:00):

Hey, everyone. This is Tom Salemi of DeviceTalks. Welcome to our newest member of the DeviceTalks podcast family, it's called MedtronicTalks. Our constant search to find new ways to bring you insights in the MedTech industry led us to the fine, fine folks at Medtronic. They've agreed to make their senior leaders available to us and you. In each episode, we'll discuss the opportunities and challenges facing one of MedTech's clear leaders so you'll have an inside view on what makes Medtronic go. We'll ask the questions, Medtronic will provide the answers and our great network of sponsors makes it all possible. So, sit back, hop on a treadmill, take the dog for a walk. Whatever you do, when you listen to a great podcast and let's listen to how Medtronic is getting the job done. Let's go.

Tom Salemi (00:45):

Hey, everyone. This is Tom Salemi of DeviceTalks. Welcome to this episode of the MedtronicTalks podcast. Really, really fascinating conversation today. I spoke with Rebecca Seidell, Rebecca is the president of Cardiac Ablation Solutions, and Dr. Robert Kowal, Robert is Vice President of Medical Affairs. He's also the Chief Medical Officer in the Cardiac Rhythm business and the Heart Failure business. And we talked about atrial fibrillation. Medtronic is making some big moves in this space. Specifically and really the primary point of our discussion is the approval of Arctic Front as a primary treatment for atrial fibrillation.

Tom Salemi (01:23):

Medical devices, as you all know are often relegated to patients who are resistant to pharmaceutical treatment. In this case, Arctic Front will be used as a first line of offense or defense in atrial fibrillation. We'll find out all the details in today's interview. So, lots going on in AFib and grateful to have Rebecca Seidel and Robert Kowal on the program. And before we start this week's interview, I'd like to bring in our sponsor Nordson MEDICAL. I'm speaking with David Zgonc. He's a vice-president at Nordson MEDICAL. David, tell me about Nordson MEDICAL. What are your capabilities and where are you located?

David Zgonc (02:05):

Nordson MEDICAL is a global expert in the design, development and manufacturing of complex medical devices and component technologies. We serve interventional, surgical and specialized medical markets as the engine of innovations that help our OEM customers save and enhance patients' lives. Today's Nordson MEDICAL has more than 50 years in the making. Since the first Nordson medical facility opened in 1968, we've been strategically building our capabilities to offer customers a complete solution to their medical device development needs. This strategic build-out of capabilities has led Nordson MEDICAL to have a global footprint of 14 development and manufacturing locations spanning the US, Mexico, Europe, and Israel. Allowing us to work directly with our customers where they are located.

Tom Salemi (02:51):

I will hear more from David Zgonc at Nordson MEDICAL a little later in our episode. Now, let's begin our conversation with Rebecca Seidel and Robert Kowal. Well, Rebecca Seidel and Robert Kowal, welcome to the podcast.

Robert Kowal (03:07):

It's great to be here, Tom.

Rebecca Seidel (03:08):

Thank you, Tom.

Tom Salemi (03:09):

I know Rob. You are a returning guest. You're on my other podcast DeviceTalks Weekly, and I'll put that link in the show notes so people can hear your story more fully. And I love to find out how both of you found your way to Medtronic. So Rebecca, let's start with you. What was your path into medical devices and ultimately working at Medtronic?

Rebecca Seidel (03:36):

Yeah, great. And great to be here, Tom. Thank you so much. I actually came in maybe a bit of a nontraditional way to med device. I'm an electrical engineer by training with master's in IT. I happened to be out on maternity leave and in the olden days, I'm going to date myself here, we used to get newspapers in the mail.

Tom Salemi (03:56):

I miss those. Yes.

Rebecca Seidel (03:58):

I miss them too. And I was looking through the paper and I saw this job. I thought, "Hey, I can do that job." And so I went in for an interview and the rest is history. But part of doing-

Tom Salemi (04:09):

A want ad? You really... you answered a want ad? That's amazing.

Rebecca Seidel (04:12):

I did. Indeed. Indeed. Absolutely.

Tom Salemi (04:19):

That's great. And so you came in and interviewed and what was it about the opportunity that appealed to you?

Rebecca Seidel (04:25):

Yeah. So at that point in time, we were doing a lot and we still are in the connected care space and with my master's in IT and some background in that space, the position was really interesting, and I was able to work with a lot of clinics and hospitals, more on the onsite side, and helping them set up their software to manage pacemakers and defibrillators. I loved it, continued to move along the path at Medtronic, moved into marketing from the customer service side, and then ultimately led the marketing team for this business, the Cardiac Ablation Systems business, and then moved to the TYRX general manager position, and then onto general manager of Cardiac Ablation Solutions.

Tom Salemi (05:05):

That's quite a use of an electrical engineering degree. That's fantastic.

Rebecca Seidel (05:11):

Thank you. Thank you very much.

Tom Salemi (05:11):

And Rob, I know you, and again, your background can be heard on our other podcasts, but you were a scientist turned physician electrophysiologist practicing for... Well, how long were you practicing for and what led you to join Medtronic ultimately?

Robert Kowal (05:27):

Yeah. So, I was practicing EP doing a lot of the ablation work, where we will be talking about, for 17 years and then joined Medtronic about four and a half years ago. And small world, when I was a physician doing the proctoring for the cryo launch in China, I met Rebecca for the first time when she was coming over as the Medtronic person. And so we met there and got to know each other through the TYRX route as well. And we talked in January a bit. When you make a big transition, like I did out of practice, it was that experience of having worked with people like Rebecca that made you realize this was going to be a good choice.

Tom Salemi (06:13):

It was Rebecca... I remember you referenced that you quickly learn you weren't the smartest person in the room anymore.

Robert Kowal (06:17):

I'm glad you remembered that comment. She is clearly one of the people I was referencing when I said that.

Rebecca Seidel (06:28):

I don't know. I don't know. I think he has to say yes to that right now, but I'm not sure that I was who he's referring to.

Tom Salemi (06:33):

We'll call it a tie and I'll take. So, let's talk a bit about an overview of AFib. It's a fascinating space and let's talk a bit about the need. What is it? Rob, if you could just paint the picture for us, what condition are you treating? And let's talk a bit about the prevalence. If you have any information about demand and procedures, that'd be great.

Robert Kowal (06:59):

Yeah. So, atrial fibrillation is when the heart's normal pattern of beating, it becomes very chaotic and irregular in the upper chambers. And that leads to a couple of things. First, it leads to an irregular beat in the lower chambers, and that can have a couple different impacts. One, it can increase the risk of stroke, it can increase the risk of developing heart failure and it can increase your chance of dying relative to not having atrial fibrillation. But probably most importantly, it changes quality of life pretty dramatically. And when you look at the fact that about 10% of people who will become octogenarians are going to experience AFib at some point. It's a big deal. It's a huge burden for not only the US, but the world.

Tom Salemi (07:49):

Excellent. I'd love to learn a little bit about the commercial overview. And in researching this, I shouldn't have been surprised, but there are a lot of competitors in this space. It seems most of the medical device companies have some products in this area. Rebecca, how do you view the competitive landscape in AFib?

Rebecca Seidel (08:11):

Yeah. So, it's highly competitive landscape where the competitors that have a number of different technologies and products can really treat all types of patients. And for us, what we're attempting to do is get into that space where we can have multiple different technologies to treat any types of arrhythmias. So, we've built a strategy and are executing on that strategy to have cryo tools, RF tools, and pulse-field ablation tools, along with the mapping and navigation system in order to be able to treat every single patient that has an arrhythmia.

Tom Salemi (08:44):

And Rob, I'm just curious, if you could put your electrophysiologist cap on for a moment, what is it that appeals to an electrophysiologist in choosing a technology? Is there just a loyalty to one kind of approach, a belief either taken from data or just experience, that this is the right way to treat AFib? Because there's certainly different ways to go at it.

Robert Kowal (09:08):

Yeah. No, I think there's a couple of things. One is, what is the underlying mechanism that you're trying to treat and what's the effective tool to get there? Secondly, and probably the thing that's been dominant in this space is the safety, right? These are patients who have a lot of issues clearly, and a lot of risks, but they're not in imminent chance of dying from it. It's a longer-term process. So, you don't want your procedure to lead to a worse outcome. So, safety becomes an important aspect. And again, one of the reasons behind the strategy Rebecca outlined, safety is a dominant force there as well. And then I think there's a little bit of a component that... We always talk about right brain, left brain. I think there are certain technologies and abilities to maneuver things that appeal to some people better than others. But I think the key principles behind looking initially at cryo and then bringing on some of these other technologies is that combination of the ease of therapy, the safety of therapy, and the consistency of the outcome.

Tom Salemi (10:19):

Gotcha. Well, let's talk a bit more about cryo. Rebecca, tell us about your approach in cryo. We'll hit upon the PulseSelect™ later on. Walk us through Medtronic's approach to treating AFib with the cryoballoon.

Rebecca Seidel (10:37):

Absolutely. So Cryo, we acquired this company about 10 years ago and it's been just a gem in the industry. It's really taken off because it's simple, it's safe and it's effective. And that's really important to both our physicians and our patients to ensure, and Rob touched on this as well, to get a great outcome with a safe procedure and to do it with speed. And so, as we've looked at how to use this tool for PVI, Pulmonary Vein Isolation, we additionally worked to continue to drive through indication expansion. So, it was first indicated for paroxysmal patients, those patients that have atrial fibrillation only from time to time. We got an indication for persistent, and now we have an indication for first-line therapy, which really allows that patient to get treatment much earlier in the course of the disease.

Rebecca Seidel (11:29):

And Rob can speak to this as well and better than I can from a physician standpoint. But the idea here is, if you don't have to put the patient on drugs, they can get treated earlier and their outcome is going to be better for the long term. And so we're excited to be able to treat patients across the spectrum of their disease state with the cryoballoon.

Tom Salemi (11:49):

Yeah. Rob speak to them, this is really a seismic shift for MedTech. We've always been relegated to the well of drugs don't work, then let's try this or that, or the other thing. How significant is this approval? We're going to take a break from this conversation to bring in our sponsor, Nordson MEDICAL. Once again, I'm visiting with David Zgonc, vice president. David, tell me what type of medical device companies do you work with?

David Zgonc (12:13):

We work closer to customers to develop primarily interventional med device solutions that enable procedures such as transcatheter valve replacement, cardiac ablation, kyphoplasty, stent deployment among many other therapies. Our solutions include both finished devices, including delivery systems, balloon catheters and cannula, as well as component offerings that include engineered shafts, medical balloons, extrusions, heat shrink tubing, and complex Nitinol components. With expertise ranging from finished devices to individual component optimization, we are uniquely positioned to partner with a broad range of customers covering the entire med device life cycle.

Tom Salemi (12:53):

And how do you help your OEM customers?

David Zgonc (12:56):

Typically, we start at the front end of the device development process, working with customers to understand the problem and developing unique solution. Once the design solution is reached, we leverage advanced modeling and proprietary testing to verify that the design meets performance requirements, ultimately taking the product into mass production through our rigorous transfer and validation process. Nordson MEDICAL makes a device and the differentiating components in the device. Elevating us in the market through a highly configurable and manufacturing platform, providing our customers with significant design freedom and flexibility from a single source.

Tom Salemi (13:32):

Finally, it sounds like you have a long history of success and a great record of growth. Tell us, where do you see Nordson MEDICAL going in the future? What kind of growth do you see happening?

David Zgonc (13:41):

Here at Nordson MEDICAL, we're constantly looking to expand our capabilities in ways that add value to our customers. Continually evaluating new technology, equipment and processes to enable new solutions that make the devices better and more cost-effective. A prime example of this was the addition of Fluortek business to our portfolio last year. This competency and fluoropolymer extrusion and PTFE allows us to offer a more comprehensive line of solutions. And when combined with our other proprietary technologies, it allows us to increase our responsiveness while providing unique solutions that only Nordson can deliver.

David Zgonc (14:15):

Additionally, we are always looking to optimize our footprint with the right capabilities and the right locations. Along these lines, exciting new step for Nordson MEDICAL is the new state-of-the-art manufacturing facility opening in Tecate, Mexico. We've been manufacturing in Mexico for the last 16 years and the new Tecate facility reflects a commitment to provide our customers with a cost optimized solution for full device manufacturing. Combined with our US locations, we provide rapid development and manufacturing options from our US sites. And as a product transitions into greater market acceptance, we can readily transfer the production into our cost optimized Tecate site. This is a real win for our customers because we can provide rapid development at launch and a defined path to an enhanced cost position.

Tom Salemi (15:01):

Thanks for joining us David Zgonc, and thanks for sponsoring this episode, Nordson MEDICAL. You could find out more information on their website, nordsonmedical.com. Now, Rob speak to them, this is really a seismic shift for Medtech. We've always been relegated to the well of drugs don't work, then let's try this or that, or the other thing. How significant is this approval?

Robert Kowal (15:27):

I don't want to overstate too much, but I think it's huge. And I'll put it back in the perspective, right? We all try to use what we think of as the simplest or safest approach of drugs first because of procedure carries those upfront risks. That said, it's not the antiarrhythmic drugs that you use to treat AFib, or that safe or effective. About 50% of patients who get these drugs fail either because they will have recurrent AFib or a significant side effect within a year. And again, going back to what I had said related to safety, depending on what other comorbidities you might have as a patient, some of these drugs have a mortality risk of up to 1% or 2% from taking them. So, they're not handled lightly. And that's why for the most part, electrophysiologists are the ones managing them.

Robert Kowal (16:20):

So, when you look back to when we were in the first study that led to approval of cryoballoon in the first place 15 years ago, at the time, you had to put people on drugs first. They were still highly symptomatic with their AFib when they came to you. And the state of the art was this point by point radiofrequency with catheters that were not as sophisticated as now and a high complication rate. And these were procedures you woke up dreading to do. And then along comes this device where you freeze for four minutes and maybe twice in a vein, and you got the effectiveness that took you a lot longer. And that's when you could see this vision to swimming upstream in AFib and getting to patients earlier and earlier. So, to see this first line data come out, it's really this culmination of what you could see 10, 15 years ago and hope would happen, and now you see it come true. So, I think it's a really big deal for patients.

Tom Salemi (17:26):

And how much of an issue is compliance? I know in other trials like renal denervation they were complicated. This was earlier on before you acquired it earlier on before Medtronic, it was a few years ago, but the issue was that patients don't always take their drugs and you can build out these models based upon full compliance, but if they don't take the drugs then all that is out the window. How big an issue is compliance in people with AFib taking their medication?

Robert Kowal (17:56):

It is. I think it's particularly an issue of compliance around the stroke prevention. I think for AFib... For the symptoms is different from hypertension or even stroke prevention is those are silent. Those... they're damaged silently until you have the stroke. Whereas AFib, a lot of people feel it and know they're in it... these are the type of patients who we're treating. And so they know if they missed their drugs or don't take them, they're more likely to go into it. But that said, they feel miserable often on these drugs. So, the compliance is really around just not liking it as opposed to forgetting and things like that.

Tom Salemi (18:36):

Understood. Now, that's a great point. That's a great point. Well-

Rebecca Seidel (18:39):

I'd like to add to that if that's okay?

Tom Salemi (18:41):

Please.

Rebecca Seidel (18:42):

The fact that patients tend to take about two to three years to actually get to an ablation, if they're indicated in this space, I think is a big deal to be able to move that much further ahead. And Rob mentioned, they just don't feel well on the drugs. And this gives them an opportunity much, much earlier to have a treatment that makes them feel better and to do better for the long haul.

Tom Salemi (19:05):

That's great. Well, let's talk about how you're commercializing this and about the sales. I would love to understand how you go about informing people about this new approach, informing patients about this new option they have. Ultimately, I assume they're going to listen to their physicians about what kind of treatment they'll get, but walk us through the commercialization effort going forward.

Rebecca Seidel (19:32):

Right. And so I would say that the electrophysiologists are already there. They believe in this. They want to treat patients earlier. And I think that's a subset of the physicians who are already on board. When we look at other physicians and other stakeholders in this space, we look at the cardiologist who believes in ablation but needs new data, new information to send the patients earlier. So, we will be having dialogue and conversations with the cardiologists to really move away from the perception that an AF ablation takes four or five hours to get done. These ablations happen in an hour to an hour and a half now. The outcomes are much better than they were five, six, even 10 years ago.

Rebecca Seidel (20:14):

And so, I think we need to really up our game with the cardiologists and help them understand what the implications are of these new data. In addition to that, patients really care about this. So we are working on a direct-to-consumer campaign where we will reach out directly to patients, explain to them what this new data says, and as well really help them understand how they can get through the care pathway much more quickly. So, we're excited about this. Direct-to-consumer is done in some parts of Medtronic, but we have not done that in the ablation space. So, it'll be great news for patients and for physicians.

Tom Salemi (20:50):

What does that messaging look like for direct-to-consumer? What point are you trying to convey to them that you think will convince them to ask about this procedure?

Rebecca Seidel (21:01):

First and foremost, patients want to understand that it's safe. And that it's as safe or safer than the existing path that they're on. And so, we have great data showing that. So, I think that's number one. And I think the second piece of it is their quality of life. And so the data also shows that their quality of life will be better with this treatment path as well. And those are the primary elements. And certainly Rob, if there's anything you want to add there, that would be great.

Tom Salemi (21:30):

Oh yeah. Rob, I'd love to understand how this feels to the electrophysiologist? How they look at a direct to consumer campaign and in having patients come in with an idea in mind, but also how are you approaching them? And it sounds like they're already there, but what kind of messages are you sharing with electrophysiologists about this option?

Robert Kowal (21:54):

Yeah. So first off with the electrophysiologist, there's a lot of attention to this space. It's been something that's been looked at. In parallel, there've been some other studies, broader studies suggesting that treating AFib earlier is better to prevent disease progression. So, this fits right in line. I think the other thing that's eye-opening is, it wasn't just our study, but there was a parallel study run out of Canada. Both were back-to-back papers in New England Journal showing the effectiveness of cryo as a first-line therapy. So, it's not often as you get back-to-back New England Journal papers in line with the same results. We often see the ones that are discordant. So, that's a big deal. You bring up an interesting point too, right? That the physicians always feel the education is their realm.

Robert Kowal (22:44):

And so, I think one of the things we've worked on as we've talked about direct to patient or direct to consumer is, what is the message? And I think as a physician, in my mind, it has to be truthful and honest and not overselling and telling the story right. And if you do that, then I think everybody can feel it's the right thing. I think it's when you start overreaching and promising things that are not really within the data set, that physicians fight back. And I think we've been really conscious about how to craft that.

Tom Salemi (23:22):

Rebecca, I'm just curious, did the naming of the device have anything to do with the direct-to-consumer focus to give it something that is easy to remember? How much of that gets consideration?

Rebecca Seidel (23:34):

Yeah. I think yes, absolutely. We want patients to understand that this can be a first-line therapy for them. It's also pretty common knowledge in the medical space that, that terminology as well. So, I think it does resonate with both patients and with physicians.

Tom Salemi (23:51):

And one area I hadn't really thought about so just now, what kind of interaction you're having with payers? Are they more inclined to pay for a drug than they will the procedure? Or do they see this as long term a cost saver? I don't know which of you may deal directly with payers or who-

Rebecca Seidel (24:07):

So, I can start there. I think that anytime there's a cost savings opportunity and the patient feels better, it's an opportunity for us to have dialogue with payers. And the long pole or the longevity of this disease for patients, if we can treat it earlier and prevent it from recurring, we'll certainly save dollars for the system as well as make the patients feel better.

Robert Kowal (24:32):

Yeah. No, I'd echo that. I think that one of the powerful pieces of having two fairly significant trials is we can start combining this data and look at economic outcomes. And I think this is a space where you've got to move away from just mortality looks to this quality of life piece. Which is harder to do, but it's really critical because you're dealing with a group of people, many who are paroxysmally fit, who are, because we're moving upstream and are earlier in their course of care, are still working, right?

Robert Kowal (25:04):

And so, it's not the retirees necessarily. There's some of that, but it's working people whose jobs have been disrupted. And how do you capture things like, I can get back to work without a concern, or I can do the family things I want to do, and monetize that to the system in terms of days at work, days not in the physician's office, days out of the emergency room, things like that. But those are the things we're looking at. And like I said, we have the power of a couple studies now to put to bear on it.

Tom Salemi (25:38):

That's great. And just final area I'd like to cover is, just your work in the pulse-field, PulseSelect™. You've got some trials going on there. How important is it, before we get into the details of that technology, to have multiple approaches to treating AFib, I guess, to have those extra shots on that? Is it necessary to have two or three or four different technologies to treat this disease?

Rebecca Seidel (26:06):

I think it is. I think that as we look to the future, there will be opportunities for cryo, RF, and pulse-field ablation in this space. The reason I say that is because there are multiple types of arrhythmias, and we talked a lot about atrial fibrillation today, but there are other things like VT, SVT. And we think that there are certainly tools that can treat across that spectrum, both disease states and the technologies. And so, I think it'll continue to be important for the long haul to have all three.

Robert Kowal (26:37):

Yeah, I would agree. And I think the other piece is, as much as we know about doing pulmonary vein isolation... And again, the reason for treating early is because the pulmonary veins are the main sources early. When you get into later phases of AFib, it's less about the pulmonary veins. And we still have a lot to learn about the mechanisms. And to be able to bring to bear different types of energy sources, depending on those mechanisms as we learn more, is going to be really critical.

Tom Salemi (27:09):

Well, that's great. Let's talk a bit about PulseSelect™, where are you with those trials and that technology?

Rebecca Seidel (27:16):

So, we're very excited about this technology. We've completed the pilot phase, it's a global trial and we're moving into the pivotal phase at this point. We're about half enrolled in this trial and we expect to finish the enrollment by the end of this calendar year. And so, it's a paroxysmal and persistent. So, a two-arm study, 150 patients in each arm. And like I said, we're getting close to finishing the enrollment. It's a year follow-up and then we'll have results at that point.

Tom Salemi (27:44):

Great. And anything to add to that, Rob?

Robert Kowal (27:49):

I would say that I was privy to this technology a long time ago. Again, before I came to Medtronic and share the same excitement from what I described when we first started using the cryoballoon. I think this is one of those things that can redefine how you go about ablation, not only from the ease and effectiveness, but again, the safety factor. If you continue to make incremental improvements in safety, it just opens the door to how you can treat people.

Tom Salemi (28:22):

Terrific. And final question, I just want to follow up on an internal issue, just the reorganization, I wonder how that has settled for you and how your life in Medtronic or work in Medtronic is different now that you're your own operating unit.

Rebecca Seidel (28:46):

So, I would say that I think this was a great move by Geoff [Martha] to organize his operating units. I think it gives us flexibility and autonomy to really drive the therapy that we have and the opportunity for patients to get therapies faster. It's largely the same for our business, given that we were organized somewhat like this before. But what I do think it will give us is, is feed in our innovation pipeline and autonomy to continue to get that work done quickly. So, I think it's a great move.

Tom Salemi (29:17):

And Rob, are you working only in this OU, or do you work for with several?

Robert Kowal (29:21):

No. I actually work with three right now, all related to the cardiac rhythm space. Our diagnostics group, our implantable cardiac rhythm group, and that's where we talked in January, and in AFib. And I agree fully with Rebecca. You can see this tangible change in the mentality of speed of performance within the groups. I think I have this really luxurious spot of being able to play in all three and be the voice of that one customer that all three serve. And so, it's a ton of fun being in this spot. And you can see that everyone's hit the accelerator with this move.

Tom Salemi (30:07):

That's great.

Rebecca Seidel (30:08):

Employees really want to be connected to the business that they serve, right? They want to see how the work that they do drives outcomes for patients and how it connects to the mission. And I think this structure really gets to that.

Tom Salemi (30:21):

Oh, that's a great point. I think that's where the satisfaction comes from dealing with the customers and solving their problems. You mentioned innovation, just curious, going forward as you search for even new tools, new technologies, not to add to your to-do list, but do you see that growth coming through internal innovation primarily? Or do you see acquisitions being a part of that strategy?

Rebecca Seidel (30:46):

I think for this business, given where we are, it will be a combination and it will continue to be a combination over time. Like I mentioned, cryoballoon was an acquisition, pulse-field ablation is done completely internally, mapping and navigation, maybe some external opportunity for us. And so, I think we'll continue to just leap frog going forward with both internal and acquisitions.

Tom Salemi (31:09):

Terrific. Well, it's a great conversation. It was a pleasure to have you both on the podcast. Thanks for joining us.

Robert Kowal (31:14):

Great fun. Thanks Tom.

Rebecca Seidel (31:15):

Thank you, Tom.

Tom Salemi (31:19):

And that is a wrap. Thanks for joining us on this episode of the MedtronicTalks podcast. Thanks to our guests, Rebecca Seidel and Robert Kowal. Thanks to our sponsor Nordson MEDICAL. And of course, thanks to you for finding us and tuning in. If you want to make it easier to find us in the future, please do subscribe. The MedtronicTalks podcast is available on all major podcast channels, Google, Amazon, Spotify, Apple. We're out there, just follow or subscribe, and you'll have future episodes sent directly to your phone or wherever you're listening to these podcasts. While there, you can also find our DeviceTalks Weekly podcast. You could find them both, of course, on our devicetalks.com website.

Tom Salemi (32:02):

In addition to subscribing, if you would please share this episode on your social media channels. And while you're doing that, please connect with me. I am on Twitter, @MedTechTom. I am on LinkedIn, Tom S-A-L-E-M-I. Whether or not you're sharing, connect with me on those social media channels. Anyway, I'd love to be part of your future MedTech conversations. That's a wrap. Thanks again to our guests. Thanks again to Nordson MEDICAL. And thanks for listening to this episode of the MedtronicTalks podcast.