Sarah Kalil likes to start each day by climbing a mountain. One of her preferred summer and fall routes is a two-mile sweatfest that begins in a glade near Stowe Mountain Resort’s Midway Lodge and ends, 2,000 unrelenting vertical feet later, at the top of the gondola lift below the Mount Mansfield ridgeline. On a good day, she said during one of her recent pilgrimages, she can reach the gondola in an hour. 

“It’s a massively efficient workout,” Kalil said, not panting very much. Her two golden retrievers, Lucy and Scout, lolloped ahead. “I’ve already accomplished something, and it’s barely 10 a.m. You can’t take that away.” In the interest of efficiency and joint health, she rides the gondola down. 

To some people, this regimen might sound like a small slice of hell. For Kalil, 63, it’s a necessary act of exhaustion before the daily sprint of running a medical technology startup, CoreMap, which she joined in 2017 with cofounder Peter Spector, a University of Vermont cardiologist. Using technology that Spector developed at the UVM Medical Center, CoreMap is seeking to achieve a breakthrough in the detection of atrial fibrillation, or AF, a heart arrhythmia that affects some 37 million people worldwide. 

AF is triggered by electrical disturbances in cardiac tissue that throw the heart’s normal beat off-kilter, elevating the risk of heart failure and stroke by as much as fivefold. AF is more common among older adults, though it can affect otherwise healthy people of any age. John Fetterman, the 53-year-old Carhartt-clad lieutenant governor of Pennsylvania who is running for the U.S. Senate, had a stroke in May that was likely caused by his AF; last month, J.J. Watt, a 33-year-old defensive lineman for the NFL’s Arizona Cardinals, had his heart shocked back into rhythm after an AF flare-up. Because the long-term consequences of AF often require medical treatment, the health care costs associated with the disease are considerable — nearly $26 billion per year in the U.S., according to some estimates. 

The most effective treatment for AF is a procedure called ablation, in which surgeons insert a catheter into a major blood vessel and zap the cardiac tissue that’s sending faulty signals to the rest of the heart. But ablations, according to Spector, are often a shot in the dark.

“We basically stumbled into an approach that works for reasons that we didn’t really understand and, therefore, we couldn’t modify to fit everybody,” he said.

The electrodes on today’s catheters aren’t sophisticated enough to capture the chaotic trajectory of the electrical glitches that cause AF, Spector explained. As many as half of all AF patients who get an ablation have to undergo more than one procedure.

Using Spector’s technology, CoreMap aims to develop a solution to the long-standing challenge of providing individualized treatment for AF — a catheter, tipped with tiny electrodes, that can detect abnormal electrical activity and feed the data into a mapping system that generates high-resolution 3D images of the heart. With those detailed visuals, Kalil said, surgeons will be able to zero in on the source of an erratic rhythm, increasing the chances of a successful ablation.

Even in the best-case scenario, CoreMap is still several years away from bringing its diagnostic system to the growing AF medical device market, which analysts predict could be worth nearly $18 billion within the next decade. Kalil said CoreMap has conducted some promising early studies at the Liryc Electrophysiology and Heart Modeling Institute, a research center in Bordeaux, France, focused on heart rhythm disorders, and the company plans to begin clinical trials outside the U.S. by early next year.

If CoreMap can secure Food & Drug Administration approval, and prove that Spector’s technology works as well as the preclinical studies seem to suggest, Kalil believes that their system will open up treatment possibilities for the hundreds of thousands of AF patients whose arrythmias elude the devices currently on the market. And if CoreMap can deliver on its goals, other companies might try to replicate their success in the Green Mountain State, where the medical technology industry has been steadily gaining momentum. (See “Picture of Health,” page 32.)

Successful companies become incubators for talent, said Jenny Barba, whose venture firm, Features Capital, invests in medical technology startups. Once a company such as CoreMap becomes well established, she explained, its employees can go on to launch their own businesses.

“Quite frankly, there’s a lot of pressure for CoreMap to win,” observed Barba, who lives in Norwich. “It’s as if the whole ecosystem is a little bit dependent upon them to show that this is possible.” 

A native of Burlington, Kalil has spent the last three decades steering fledgling medical technology companies through the rigors of product development and regulatory approval. She lived and worked mostly in the Boston area until 2016, when she and Spector met through a mutual acquaintance, Deb Estabrook. At the time, Spector had already patented his catheter design, and Estabrook thought Kalil might have the expertise to help him turn his ideas into a viable enterprise.

“Sarah is great at making connections very quickly,” said Estabrook, a retired equity trader who lives in Shelburne. “She’s smart, she’s warm, and she’s very, very hardworking. She’s kind of like the Energizer bunny.”

After Estabrook introduced them, Spector periodically called Kalil for advice. One day, he asked her to come to Vermont to meet a candidate he was considering for a role at the company. While Kalil and Spector were waiting in line for sandwiches in Winooski after their meeting, Kalil said, Spector asked her if she would be interested in becoming his CEO. Right there in the sandwich line, Kalil agreed.

“It’s pretty unusual that two people can agree to work together under those circumstances,” Kalil said. “But it set the tone for the company that we were able to arrive at that level of trust so quickly.” 

The startup world is replete with these kinds of origin stories — the road almost not taken, the chance meeting in the coffee shop that turns into a daylong ideation bonanza — and Kalil, a doer in the extreme, is both a pragmatist and an embracer of the unknown.

“I love velocity. I love change. And in early stage companies, the goal is to constantly be changing,” Kalil said.

In the early ’90s, she was one of the first 10 employees at a startup that developed a 3D surgical endoscope. Kalil was five months pregnant when she was hired, and there were no other women on the team. After her son, Sean, was born, her coworkers bought her a crib for her office. Sean came to work with her for the next year and a half, until Kalil, who was by then pregnant with her daughter, Maura, decided to start her own consulting business so she could spend more time with her children. (Sean now works for CoreMap as an engineer.)

Kalil grew up in the New North End of Burlington. Her mother, one of 11 children raised on a dairy and maple sugar farm in Fairfield during the Great Depression, worked as a teacher at C.P. Smith Elementary School. Kalil’s father, a former fighter pilot, sold insurance.

Kalil, the youngest of four, was athletic — she was on the field hockey, tennis and downhill ski teams at Burlington High School — and excelled in math and science. At UVM, she majored in engineering, where she could count her female peers on one hand. “There were professors who made me feel that I was taking a spot from a man,” Kalil recalled. “Well, I was not leaving.” 

When she first entered the male-dominated world of medical technology, Kalil said, she thought that she could perform her way out of discrimination based on her gender. “I just always said that I was going to be better than the person on the right or the person on the left, that I would work harder and work smarter and be better,” she said. 

In 2018, Kalil went back to school for a degree in pharmaceutical and medical device law from Seton Hall University. There, she took a course on constitutional law that covered affirmative action, which changed her view of her own situation. Now, she believes that success isn’t simply a matter of individual achievement: “It’s easy for me to take that position because someone read me a bedtime story, checked my math homework, fed me meals, made sure I went to school.” As the CEO of a growing company, she said she feels an obligation to ensure that the people she hires have the support they need to do their best work. 

The gender gap in the medical technology sector remains stubbornly wide. Only 15 percent of executives at venture-backed medical technology companies are women, according to a 2021 survey by the trade publication MedTech Pulse, and women-led startups receive just 2.3 percent of all venture capital funding. “I would guess that Sarah probably works harder than many CEOs in this space, just being in Vermont and being a female,” said Barba of Features Capital. 

Of CoreMap’s 26 employees, 10 are women, including Kalil. The majority of the team works at CoreMap’s facility in Burlington, Mass., where the company is developing its catheter and mapping software; Kalil, who lives in Stowe, splits her time between the Massachusetts plant and CoreMap’s local headquarters at Hula, in the South End of Burlington.

Kalil said she’d like to hire more Vermonters — CoreMap currently employs four — but the applicant pool is small, particularly for technical roles. “This domain is so complex and specialized, and it’s just not here,” she said. “It’s in California, in Minneapolis, in Boston.”

Since 2017, CoreMap has raised a little over $33 million. One of its first investors was Boston Scientific cofounder John Abele, who has given away much of his considerable fortune to philanthropic causes; his net worth, according to Forbes, is now some $640 million, down from $1.5 billion in the mid-2000s. 

Abele knows AF on both a personal and a professional level. Boston Scientific has manufactured ablation catheters since the 1980s, and Abele’s wife, Mary, used to be one of Spector’s patients at UVM Medical Center. At 85, Abele still likes to keep one toe in the next frontier. Part of the reason he placed a bet on CoreMap, he explained, was his confidence in Kalil’s ability to translate Spector’s research into real-world technology. 

“Sarah has always appeared to me as an amazingly practical, can-do type of person,” said Abele, who meets with Kalil at least once every few months to talk about strategy. “To be an entrepreneur, you don’t survive unless you cross borders, because you need to be broad in order to understand all the things that are going to be necessary to accomplish a project. And that’s exactly what she does.”

Other companies have tried to do what CoreMap has set out to accomplish, Abele noted, and one of Kalil’s challenges will be to dispel the lingering skepticism from the failures of her predecessors. “When a field has been through a lot of broken glass, then people say the next thing is also going to be broken glass,” Abele said. “But I think that’s absolutely surmountable.” 

In fact, Kalil has faced much more harrowing trials. In 2011, she was diagnosed with aggressive metastatic breast cancer, which required 10 surgeries, 32 chemotherapy sessions, and a month and a half of radiation.

When she first learned that she had cancer, Kalil said, she fixated on whether she’d live to see her children get married. As it happened, her daughter got married last month, and Kalil was there to zip up her wedding dress. “The whole time, I was thinking that it could have been somebody else, and it got to be me,” she said. Her son is planning to get married in June. 

Kalil no longer gets routine cancer screenings; instead, her doctors have advised her to wait for symptoms. “I wouldn’t know a symptom if it hit me on the head,” she said. “I’m too busy.”

So she gets up each morning, climbs a mountain and goes to work, hoping that all of her effort will mean that, someday, one more person might live to see her children grow up.