With FDA approval for Impulse Dynamics' heart failure device in hand, the group has now presumably switched focus to planning its flotation – at least this was the company’s plan as it was explained to Vantage last year. The Optimizer Smart is a cardiac implant that uses electrical impulses to strengthen heart muscles in patents whose heart failure cannot be treated with drugs, but is not severe enough to warrant the use of left ventricular support devices. The US approval covers its use in patients with reduced ejection fraction – the amount of blood pumped out in each heartbeat – and the company is now working to expand into patients with preserved ejection fraction. A 60-patient trial in this population is ongoing and could report in 2021. Before that, though, Impulse ought to go public, probably in the US, if it sticks to its initial strategy. That said, it should be remembered that FDA approval often presages a takeover – it is just possible that Impulse might not make it to a stock exchange after all.