Describe CardioOptics' SiteSeekir technology. What types of procedures can it be utilized for? CardioOptics developed a fiberoptic catheter that allows direct vision inside the heart. It uses a laser beam, filtering out a certain frequency of the spectrum (red), thus allowing visualization of the heart structures through blood. Currently this technology has FDA approval for cannulation of the coronary sinus, but new applications (visualizing the Fossa Ovalis for transseptal puncture or the pulmonary veins) are conceivable. How many cases has the SiteSeekir technology been used on so far at the Cleveland Clinic? Also, when was the first procedure using the SiteSeekir technology performed at your institution? We have used the technology 5 or 6 times so far, the first time in May 2006. Describe the first case using this technology (including how long the procedure took, any complications or difficulties, etc.). In addition, was there an ease of use when using this technology, or was there a learning curve? The first case was an implantation of a biventricular ICD. CardioOptics helped with the insertion of the LV lead into the coronary sinus by allowing me to visualize the coronary sinus OS and branches and cannulate it under direct vision. There was no complication, and the procedure took a little over two hours. There was a learning curve using the catheter, especially learning to stabilize it and advance it with small movements. How is this technology different from what is currently available on the market? To my knowledge, there is only one other product on the market that has only recently gained approval for the same indication. It is a balloon catheter that allows visualization of the structures the balloon is in contact with. I have not used this technology myself. The difference is that the balloon has to touch the structures you wish to see, and it probably would not work inside veins like the coronary sinus. It seems to be designed to see the OS, but not the side branches. What makes this technology so beneficial? (e.g., does it cut procedure time or reduce complication rates?) How do you see this technology being utilized in the future? The CardioOptics technology is particularly beneficial in difficult cases, especially when the OS of the coronary sinus is in an unusual location and cannot be found easily, or when a Thebesian valve obstructs the OS. It is also useful to look at other cardiac structures that up to now remained unseen and could only be visualized indirectly with other methods like ultrasound, X-rays or MRI. I think in the future it will be utilized to visualize ablation sites (pulmonary veins), valves and other structures targeted for catheter-based interventions, and help with transseptal procedures. How is the first patient who used the technology doing today? The first patients we used the technology on have improved clinically after their discharge, and to my knowledge have not been re-admitted to the hospital. Their exercise capacity in particular has seen a significant increase. Is there anything else you'd like to add? The technique and the catheters will no doubt be refined and improved, and we will learn how and when to apply this technology to cut procedure times and increase the safety of the procedures we perform.