Eliminating Ambiguity 

in Atrial Fibrillation

Ablacon aims to improve patient outcomes after ablation therapy by giving electrophysiologists a more nuanced view of the pathophysiology of atrial fibrillation.

By Stephanie Kreml

Peter Ruppersberg, Chief Scientific Officer & President

Peter Ruppersberg’s drive to improve how atrial fibrillation (AF) is treated started when he developed the condition himself. “In 2004, I had an attack of atrial fibrillation due to my congenital mitral valve prolapse, which was subsequently repaired,” he says. “Through this problem I became fascinated by the complex behavior of atrial circuits spontaneously forming in AF.”

As a result, Ruppersberg has been on a quest to help electrophysiologists obtain better outcomes for atrial fibrillation ablation procedures. Of course, it helped that Ruppersberg already had a relevant background to begin this quest. Before founding Ablacon in 2015, where he now serves as President and Chief Scientific Officer, he worked in experimental electrophysiology on a Nobel Prize-winning team at the Max Planck Institute in Heidelberg, Germany. He then went on to become a professor of electrophysiology (EP) and biophysics at the University of Tübingen.

Ruppersberg eventually left academics to work with several medical device startups. But after his personal experience with atrial fibrillation, he is now focused on solving issues where other atrial mapping approaches fall short. He laments, “Several technologies have been tested in clinical trials, but none have shown statistical proof that they can successfully guide therapy and help physicians achieve better outcomes for patients.” With Ablacon, Ruppersberg aims to change this.

Ablamap Electrographic Flow Visualization

Pulmonary vein isolation is the mainstay ablation treatment for persistent atrial fibrillation, but high recurrence rates contribute to suboptimal outcomes. Ablacon’s Ablamap® platform analyzes data from a 64-pole basket catheter to create a global map of the atrium that can show time-dependent electrical behavior and identify corresponding areas of atrial tissue for targeted ablation.

“Ablamap® is used in conjunction with traditional EP technologies like recording systems and navigation systems,” Ruppersberg explains. “It provides a new layer of information that allows the treating physician to go beyond anatomy-based treatment algorithms, like pulmonary vein isolation, and gain an understanding of the pathophysiology driving the arrhythmia.”

Ruppersberg goes on to say the company “is working to leverage its advanced algorithms and machine learning techniques to visualize and quantify the complex electrical information available. We call this visualization the Electrographic Flow.”

Ablacon’s work advances beyond existing mapping technologies, which are based on phase mapping or activation mapping algorithms. Philip Haeusser, the Chief Technology Officer of Ablacon, explains, “In our case, the model is a complex, fully parameterized data processing pipeline that can process and interpret unipolar electrograms far better than the eye of an electrophysiologist.” The resulting Electrographic Flow visualization gives clinicians a full spatial and temporal reconstruction of cardiac action potentials and their flow within the atria.

This approach allows Ablamap® to differentiate between passive flow disturbances in the atria caused by structural remodeling and active AF sources, which are critical for the maintenance of or the reinitiation of AF. Ablamap’s® advanced real-time visualization of patient-specific cardiac action potential flow also distinguishes whether the electrical conduction emanating from an active source flows out from a single focus in all directions to the surrounding tissue or whether the activation is rotational. Identifying these AF drivers not only facilitates precision targeting and ablation, but also means that the physician can customize the ablation strategy to each individual patient rather than employing empiric ablation lesion sets. Furthermore, on a population level, based on these source patterns, ongoing research has revealed that distinct AF phenotypes or source signatures exist, which may change how we currently classify AF patients, potentially predict ablation outcomes, and ultimately transform the way we treat AF.

Haeusser adds, “We are convinced that this will give the doctor more meaningful data so that they can treat patients more efficiently, based on patient-specific data and backed with statistical confidence from a large number of cases.” The novel information Ablamap® provides to electrophysiologists will further the field’s understanding of the underlying pathophysiology of AF and advance the field beyond the pulmonary veins, enabling physicians to personalize and more precisely treat each patient’s AF, resulting in improved patient outcomes.

Characterizing for Clarity

Ruppersberg’s experience as an entrepreneur when he developed AF pushes Ablacon forward. “At that point in time I had just stepped out of my university career and started working as a coach for startup companies to help them raise seed funding,” he says. “Through this work I was confronted with early applications of artificial intelligence and understood the huge potential that an application of AI in electrophysiology could have.”

To get the company started, Ruppersberg bootstrapped Ablacon for three years with funds he and his wife, Francesca, earned while managing several medical device and healthcare companies. Ablacon is based in Colorado where Ruppersberg’s last company was located. When Philip Haeusser joined Ablacon as Chief Technology Officer, the company opened a research and development facility in Munich, Germany. Haeusser’s experience developing the first neural network-based optical flow detector while doing research at Google helped build Ablamap®’s solid technical foundation.

After Ablacon obtained its CE mark for Ablamap®, Ruppersberg successfully raised a Series A financing from Ajax Health, a California-based medical technology investor, and brought Ajax Health founder Duke Rohlen on as CEO in 2019. Rohlen’s experience successfully running five prior companies adds another seasoned veteran to Ablacon’s team. “I have garnered a lot of knowledge about what makes teams, technologies, and business models succeed or fail,” he says. “Ablacon is powered with a team and resources to get answers to very complex questions in the shortest period of time possible.”

With Rohlen’s leadership, Ablacon is gearing up to enter the cardiac mapping market and make a difference. He states, “Ablacon is transitioning from planning into attack mode, and the information that we are getting is compelling and potentially enormously impactful to AF disease treatment.”

As far as competition is concerned, Ruppersberg is not worried. “The electrophysiology landscape is dominated by large companies like Biosense Webster, Abbott, Medtronic, Boston Scientific, and Philips,” he says. “We think that the Ablamap® technology is actually complementary to these companies’ technologies rather than competitive — it provides an additional layer of information to allow an understanding of the pathophysiology of atrial fibrillation.”

Building an Experienced Team

Ablacon is building its case for success. “Ablacon has carried out two retrospective studies in Germany and the Netherlands which are not yet published,” Ruppersberg says. Ongoing studies will provide the evidence the company needs to enter the market. He adds, “One investigator-sponsored prospective study is currently running in Rotterdam, and a company-sponsored multicenter randomized prospective study began enrolling in September.”

With these studies, Ablacon aims to elevate the field of electrophysiology to the next level. “Electrophysiology is a complex area of medicine, and AF is a complex disease state,” says Rohlen. “It’s Ablacon’s ability to break through this complexity to give physicians actionable treatment guidance that makes it an exciting and potentially extremely impactful company.”

Ablacon’s team wants to make a mark on the field of electrophysiology. “I believe that we will end up with the most powerful technology in the space,” Rohlen states. “It will provide information to physicians and patients that will change the way AF is categorized and treated.”

Poised to Make a Mark

We believe that the next big healthcare revolution will be driven by the coupling of data science and medicine.

Peter Ruppersberg

Chief Scientific Officer & President, Ablacon

[Ablamap®] will provide information to physicians and patients that will change the way AF is categorized and treated.

Duke Rohlen