Interview With CathEffects Founder Jawahar Desai, MD, and Shawn Fojtik

Chief Executive Officer Jawahar M. Desai, MD, FACC, has over 20 years of experience in the field of Cardiology and Electrophysiology. He is a published author and holds 17 U.S. and international patents issued in his name. Chief Operating Officer Shawn Fojtik has over 15 years of sales, sales management, medical device development, marketing management, and international sales and marketing experience. He holds 2 U.S. and international patent applications in his name. I was introduced to the two of them at this year's Atrial Fibrillation meeting in Boston on January 18-19th. Later, I had the opportunity to speak with them regarding their views on current and future treatments in atrial fibrillation.

EPLD: Were you able to attend any of the sessions at the Atrial Fibrillation meeting? What new information did you see come out of this year's meeting?

JD: The Boston Atrial Fibrillation Meeting has now established itself as a premier must-go meeting. The overall meeting, in listening to other colleagues as well, was excellent. The most important topics discussed were mechanism of atrial fibrillation and catheter ablation of atrial fibrillation. Catheter ablation of atrial fibrillation is going to emerge and will be the modality of treatment that will soon come to pass. With rapidly accumulating data from multiple centers regarding mechanism of focal atrial fibrillation initiators, consensus seems to be building in favor of performing both linear ablation and pulmonary vein isolation in patients with chronic atrial fibrillation. There was also interesting information about other energy sources like cryo. In addition, the presentation by Dr. Gus Vlahakes on surgical anatomy of the atria and pulmonary veins was excellent and timely, reminding electrophysiologists to exercise caution and judgment while performing these procedures.

EPLD: What are some of your expectations for this year's upcoming meetings and trade shows?

JD: The discussion on mechanism of focal atrial fibrillation, catheter ablation of atrial fibrillation, and new energy sources, will continue to dominate future meetings. The data presented at the meeting on linear ablation with pulmonary vein isolation using RF energy by Dr. Neal Kay looks very convincing. Dr. Warren Jackman s presentation on the use of new high-resolution Lasso catheter recordings to discriminate left atrial potentials from pulmonary vein potentials is another topic to look for. Dr. Jackman s work may allow physicians to perform more discrete ablation with fewer complications.

EPLD: Describe your medical background.

JD: I was trained at the University of Bombay in India as a cardiologist. In 1975, I met Dr. Melvin Scheinman at the World Congress on Electrocardiography in Bombay. I discussed my interest in pursuing clinical cardiac electrophysiology as a career and within a few months he accepted me as his fellow. I am proud to say that I was Dr. Scheinman s first Electrophysiology Fellow at the University of California-San Francisco. After completing my fellowship, I moved to the University of California-Fresno campus as Director of Clinical Cardiac Electrophysiology.

EPLD: Working with Dr. Scheinman at the University of California must have been a very exciting time for you. How long were you at the Davis campus?

JD: Dr. Scheinman is a master teacher it was the best time of my life as a student. In 1987, I came to the University of California-Davis campus as Director of Cardiac Electrophysiology. I worked at UC Davis from 1987 to 1992. I have been in private practice since 1992.

EPLD: What made you interested in getting into the research and development of electrophysiology products?

JD: Electrophysiologic mapping studies are time consuming, as they require insertion of multiple linear catheters and analysis of the signals recorded from multiple sites. Linear catheter mapping is random and has no directionality. The mapping study can take hours and the resolution may not be precise. In order to overcome this problem, the VectorCath was conceived. The Desai VectorCath has directionality guiding the physician to the endocardial breakthrough site. At the breakthrough site, the Desai VectorCath can map a one square centimeter area under the electrodes, electrophysiology can be performed, the site confirmed, and then ablated. Precision mapping with the Desai VectorCath can take minutes.

EPLD: You hold 17 patents. Can you describe some of them?

JD: I have patents issued and pending for mapping catheters, mapping systems, multi-phase radiofrequency ablation, and angiography catheters.

EPLD: Discuss some of your involvement with Dr. Todd J. Cohen.

JD: I met Dr. Cohen when he was training at University of California-San Francisco. He was considered to be an outstanding electrophysiology fellow with great promise. He likes the VectorCath concept and has shown interest in using the catheter and mapping system when available.

EPLD: Do you still write as often as you used to?

JD: For the last several years, I have devoted my time to writing patents.

EPLD: Going back to the time when you were Director of EP at the University of California-Davis, what challenges did you often face?

JD: The faculty was very supportive of my research work. The research trend at the time was to go more towards basic science that included cellular and molecular electrophysiology. This was a challenge, because my interest and work was more related to clinical cardiac electrophysiology. As part of clinical faculty, I had to do my share of clinical cardiology duties. Finding time for all of these activities was difficult.

EPLD: I bet you have seen a lot of advancements in EP.

JD: Catheter ablation can cure cardiac arrhythmia I was an electrophysiology fellow when Dr. Scheinman performed the first experimental cardiac ablation. Dr. Scheinman is a true pioneer; very few physicians develop trail-blazing treatments to benefit humanity. He conceived, developed and performed the first human ablation opening the field of catheter ablations for cardiac arrhythmias. Because of his vision and drive, thousands of patients are cured of their arrhythmia and not visiting emergency rooms anymore to terminate their tachycardias. Other pioneering developments that happened during my time include automatic implantable cardiac defibrillators and radiofrequency ablation of cardiac arrhythmias.

EPLD: Are you currently involved in any research products?

SF: Our first commitment is to patient care and safety. This commitment requires us to find ways to improve our quality, performance, and procedural advantages every day. Therefore, the majority of our time and resources are devoted to the research and development of current and future products. Our research includes laboratory bench testing, pre-clinical in vivo studies, and post-market release clinical studies. Research is expensive, but it will always be the first check we write, so long as it improves the safety and efficacy of our products. JD: The VectorCath has been used in 70 animals. The VectorCath has been used to map and ablate in 20 patients outside the United States. The abstract of this work has been submitted to upcoming meetings. Currently, we are developing new protocols for VectorCathRF Ablation Catheter. This work has been very rewarding and has given me a lot of insight.

EPLD: Are you developing any additional products or devices?

SF: Yes; the Desai VectorCath Mapping Catheter line will soon grow with improved small and large curve selections. We are also working on the Desai VectorCathRF Ablation Catheter that will combine fast, accurate mapping with precision ablation from multiple electrodes. In addition, CathEffects is developing specialty angiography products to improve basic diagnostic procedures. Today, CathEffects has two FDA-cleared products ready for commercial sale: the Desai VectorCath Mapping Catheter and the Desai VectorCath Mapping System.

EPLD: What were your reasons for developing the Desai VectorCath Mapping Catheter, Desai VectorCath Mapping System, and the Desai VectorCathRF Ablation Catheter. What makes them different than other products on the market at this time? How does each work?

SF: Improving patient care through faster and more accurate mapping is what drove our development teams. Our products are different from others in their ease of use, speed, accuracy and price. JD: The reasons for developing the VectorCath were that the standard technique involved introducing multiple catheters (up to 4-6 in the heart) to map an arrhythmia, such as in a typical tachycardia. However, when using VectorCath, you may only need one catheter for mapping some arrhythmias. SF: The Desai VectorCath Mapping Catheter is only a two-plane, five-electrode mapping catheter that gives you vector directionality toward the endocardial breakthrough with the use on any existing EP recording system. In short, the catheter is like having five equal distant catheters simultaneously recording signals for you with each move. The Desai VectorCath Mapping System works with a standard EP recording system and requires no special patient or procedural preparations. With the click of a mouse, the system displays local isochronal activation of the endocardium beneath the catheter s array with a directionality arrow and distance estimate pointing toward the breakthrough. SF: When I first met Dr. Desai, he stressed how he wanted the VectorCath technology to be within financial and functional reach of every lab in the world. He did not want an expensive rich man s, research or difficult case only mapping system. The Desai VectorCath mapping catheter and mapping system fulfills Dr. Desai s requirements with an advanced mapping combination that can be mastered in minutes and costs significantly less that other system. We are fortunate to receive many accolades when demonstrating the system, but perhaps the best is when people refer to us as a complementary and/or basic version of their current advanced mapping system that costs thousands more per catheter and hundreds of thousands more per system.

EPLD: When did you begin to work with Shawn? Can you describe how CathEffects was started?

JD: Shawn joined me in October of 2000. He previously worked for Boston Scientific; the last company he worked for was the OEC division of General Electric. Shawn is an integral part of this company and has done a superb job. He has got the company where it is today.

EPLD: What advances do you think we'll see in the field of electrophysiology in the next couple of years?

JD: I think the next advances we ll see, especially in the next five years, will be in the treatment of atrial fibrillation, such as catheter ablation. This is going to come and stay. After that, I believe a lot of molecular information will emerge and help us be more precise and scientific in eliminating arrhythmias.

EPLD: Thank you very much for this opportunity to speak with the two of you today and for sharing your thoughts with EP Lab Digest.