Earnings Call Transcript - ATRC Q1 2026

Operator, Operator

Good afternoon, and welcome to AtriCure's First Quarter 2026 Earnings Conference Call. This call is being recorded for replay purposes. I would now like to turn the call over to Marissa Bych from the Gilmartin Group for a few introductory comments.

Marissa Bych, Investor Relations Representative

Great. Thank you. By now, you should have received a copy of the earnings press release. If you have not received a copy, please call (513) 644-4484 to have one e-mailed to you. Before we begin today, let me remind you that the company's remarks include forward-looking statements. Forward-looking statements are subject to numerous risks and uncertainties, many of which are beyond AtriCure's control, including risks and uncertainties described from time to time in AtriCure's SEC filings. These statements include, but are not limited to, financial expectations and guidance, expectations regarding the potential market opportunity for AtriCure's franchises and growth initiatives, future product approvals and clearances, competition, reimbursement and clinical trial enrollment and outcomes. AtriCure's results may differ materially from those projected. AtriCure undertakes no obligation to publicly update any forward-looking statements. Additionally, we refer to non-GAAP financial measures, specifically constant currency revenue, adjusted EBITDA and adjusted loss per share. A reconciliation of these non-GAAP financial measures with the most directly comparable GAAP measures is included in our press release, which is available on our website. And with that, I would like to turn the call over to Mike Carrel, President and Chief Executive Officer.

Michael H. Carrel, President and Chief Executive Officer

Great. Good afternoon, everyone, and welcome to our call. AtriCure is off to a strong start in 2026 with worldwide revenue of $140 million in the first quarter, reflecting 14% growth year-over-year. We are building on the momentum we established in 2025 from new product launches with this quarter marking an acceleration in our worldwide growth rate from the preceding quarter and comparable quarter last year. Fueling this acceleration is our U.S. business, which drove approximately 15% in the quarter from expanding adoption of AtriClip FLEX-Mini and PRO-Mini devices, cryoSPHERE MAX probe and continued strength from our EnCompass clamp. In addition, we generated $17 million in adjusted EBITDA, nearly double the first quarter of last year. Our results this quarter once again demonstrate our ability to deliver durable, double-digit revenue growth and expand profitability. Beyond our financial results, we have made exceptional progress in our BoxX-NoAF clinical trial. Since initiating trial enrollment in the fourth quarter of last year, we have enrolled approximately 300 total patients. To date in this 960-patient randomized controlled trial, we are tracking well ahead of our original timeline and now expect to complete enrollment around the end of this year, nearly 1 year ahead of plan. The pace of enrollment in this trial reflects an extremely high level of engagement from surgeons who experienced firsthand the impact postoperative Afib has on their patients. As a reminder, up to half of cardiac surgery patients without pre-existing Afib will develop postoperative Afib, which is the most common complication of cardiac surgery. Because there is no established treatment today, postoperative Afib is a substantial burden on health care spending, with estimates exceeding $2 billion annually in the U.S. alone. We are confident that our BoxX-NoAF clinical trial utilizing our EnCompass clamp and AtriClip device has the potential to meaningfully change treatment outcomes for this patient population and address the significant unmet clinical need. BoxX-NoAF is also highly complementary to our LeAAPS clinical trial, studying stroke reduction benefit of left atrial appendage management in cardiac surgery patients without atrial fibrillation. We expect both of our landmark clinical trials to generate robust clinical evidence in support of preventative treatment for cardiac surgery patients, unlocking a massive global market opportunity for AtriCure while establishing new standards of care in cardiac surgery. We at AtriCure are well positioned to realize these significant catalysts for our business in the coming years. Now on to updates covering franchise performance in the first quarter. Pain management once again led our portfolio growth, increasing 28% year-over-year. The cryoSPHERE MAX probe continues to be the primary driver of growth, contributing roughly 70% of our pain management sales this quarter. Surgeons across both new and existing accounts recognize the significant time savings and clinical effectiveness it provides, leading to more patients having their postoperative pain managed effectively. Building on our legacy of innovation, we are also pleased that our cryoXT probe for amputation procedures is beginning to gain traction. We continue to receive outstanding feedback from each new surgeon that uses this device and through our registries are capturing clinical outcomes for this therapy. We are still in the early innings for cryoXT therapy development and adoption. However, we remain confident in cryoXT contributing more meaningfully as we move to the back half of 2026. Within our cardiac ablation franchises, worldwide open ablation revenue grew 15% in the first quarter, led by steady adoption of EnCompass clamp in the United States and Europe. EnCompass is delivering growth from both new and existing accounts even as we approach the 4-year anniversary of our U.S. full market launch. As mentioned in our fourth quarter earnings call, our efforts to drive treatment of Afib in cardiac surgery patients was validated with a recent announcement from the Society of Thoracic Surgeons' Annual Meeting, including concomitant Afib treatment as a quality metric. There is strong precedent for the impact of quality metrics in cardiac surgery, and we believe this change will support increased adoption for surgical Afib ablation and appendage management, serving as a durable tailwind for growth for years ahead. Our minimally invasive ablation franchise continued to face headwinds in the first quarter. We believe there is a role for hybrid therapy in the current and future treatment landscape and remain committed to providing a solution for the unmet need for patients with long-standing persistent Afib. Finally, turning to our appendage management franchise, which saw 16% growth worldwide, driven by both our open and minimally invasive appendage management products. Our open left atrial appendage management business benefited from strong adoption of AtriClip FLEX-Mini in the United States, where we exited the quarter with FLEX-Mini contributing approximately 40% of our open appendage management revenue. More importantly, we believe our FLEX-Mini device has been impactful in driving share gains in this market. Surgeons using or trialing competitive devices are impressed by the small form factor of AtriClip FLEX-Mini, along with robust clinical evidence and superior product performance of our AtriClip devices. In minimally invasive procedures, AtriClip PRO-Mini is building upon that adoption in the U.S., providing a pricing uplift that offsets pressure of our hybrid AF therapy procedure volumes. It remains clear that differentiated innovation plays an important role in maintaining our position as the leader in appendage management in cardiac surgery, and we continue to prioritize investments in this platform. In our international markets, we are growing adoption across our legacy left atrial appendage management devices. Following the first quarter, we received CE Mark under EU MDR in Europe for both AtriClip FLEX-Mini and PRO-Mini devices and expect to launch both products in Europe later this year. New product launches in Europe, the United States, China and Japan, coupled with the future LeAAPS clinical trial outcomes, provide a long runway for growth in our appendage management franchise. In closing, the performance we delivered this quarter underscores the power of our innovation and focus on execution, while the rapid progress in our BoxX-NoAF clinical trial reinforces the significant opportunity ahead at AtriCure. We remain committed to advancing standards of care, scaling responsibly and delivering durable growth with improving profitability for our shareholders. And with that, I'll turn the call over to Angie Wirick, our Chief Financial Officer. Angie?

Angela Wirick, Chief Financial Officer

Thanks, Mike. Worldwide revenue for the first quarter of 2026 was $141.2 million, up 14.3% on a reported basis and 12.8% on a constant currency basis versus the first quarter of 2025. Our performance reflects substantial growth driven by the continued adoption of key new products in the United States and many regions throughout the world. On a sequential basis, worldwide revenue increased approximately 1% compared to the fourth quarter 2025. First quarter 2026 U.S. revenue was $116.2 million, a 14.9% increase from the first quarter of 2025. Open ablation product sales grew 17.3% to $39.1 million, fueled by the strong and sustained adoption of our EnCompass clamp across new and existing accounts. U.S. sales of appendage management products were $48.4 million, up 14.9% over the first quarter of 2025, driven primarily by increasing adoption of our AtriClip FLEX-Mini and PRO-Mini devices. U.S. MIS ablation sales were $6.4 million, a decline of approximately 25% over the first quarter of 2025. And finally, U.S. pain management sales were $22.4 million, up 29.5% over the first quarter of 2025, led by the cryoSPHERE MAX probe, which contributed approximately 70% of pain management sales in the quarter, driving increased adoption in both thoracic and sternotomy procedures. International revenue totaled $25 million for the first quarter of 2026, up 11.5% on a reported basis and up 3.3% on a constant currency basis as compared to the first quarter of 2025. European sales were $16.1 million, up 13.2% and Asia Pacific and other international market sales were $8.9 million, up 8.4%. International growth was tempered by continued uncertainty in the U.K. as well as lower distributor sales in Asia. Offsetting these headwinds, we saw significant growth across franchises in other major geographies, largely driven by our direct markets. Gross margin for the first quarter of 2026 was 77.4%, up 246 basis points from the first quarter of 2025. The increase was driven primarily by favorable product and geographic mix with strong U.S. performance propelled by our new product launches and adoption. Transitioning to operating expenses for the quarter, total operating expenses increased $10.2 million or 10.3% from $98.6 million in the first quarter of 2025 to $108.8 million in the first quarter of 2026. Rapid enrollment in our BoxX-NoAF clinical trial, which offsets a decrease in LeAAPS clinical trial costs, along with increased headcount focused on product development initiatives, resulted in a 7.6% increase in research and development expense from the first quarter of 2025. SG&A expense increased 11.2% from the first quarter of 2025 as we continue to support growth while driving leverage across the organization. Completing the P&L, first quarter 2026 adjusted EBITDA was $17.1 million compared to $8.8 million for the first quarter of 2025, representing a 95% increase. We recorded net income of approximately $100,000 compared to a net loss of $6.7 million in the first quarter of 2025. Earnings per share and adjusted earnings per share were both breakeven at $0.00 compared to a loss per share and adjusted loss per share of $0.14 in the first quarter of 2025. Our results reflect a balanced approach to allocating capital towards areas we believe will sustain and accelerate growth, all while continuing to improve profitability. Now turning to our balance sheet. We ended the first quarter with approximately $146 million in cash and investments. Cash burn for the quarter was slightly improved from the first quarter of 2025 and reflects our normal pattern of cash usage, driven by share vesting, variable compensation and operational needs. As we move through the remainder of the year, we expect positive cash flow, resulting in full year cash generation that is moderately higher than 2025. Our balance sheet remains healthy and supports both current operations and our investment in strategic initiatives that we believe will drive long-term value creation. And now on to our outlook for 2026. We are reiterating our expectations for full year revenue of $600 million to $610 million, reflecting growth of approximately 12% to 14% over full year 2025 results. Consistent with our first quarter results, we expect performance over the remainder of the year to be driven by our pain management, appendage management and open ablation franchises and partially offset by continuation of headwinds from our MIS ablation franchise, along with certain international markets. For the second quarter, we anticipate typical seasonality translating to mid-single-digit sequential growth. On gross margin, while our first quarter 2026 results were exceptional as a result of extremely favorable mix, we continue to expect modest improvement in full year 2026 gross margin over full year 2025. Product and geographic mix are expected to be favorable in the near term. However, we will bring our expanded manufacturing facilities online in the second half of 2026, which will increase manufacturing cost burden, moderating the full year gross margin outlook. Turning to operating expenses. As Mike mentioned, the accelerated timing for full enrollment in our BoxX-NoAF clinical trial has placed us significantly ahead of schedule, and we now expect full enrollment of the trial around the end of this year. As a result, over the next 3 quarters, we expect additional R&D investment. While the cost of BoxX-NoAF acceleration is incremental to our plan, we continue to drive strong gross margins and operating leverage, reflecting discipline across our business. With that in mind, we are reiterating our expectations for full year 2026 adjusted EBITDA of $80 million to $82 million and full year net income, translating to earnings per share of approximately $0.00 to $0.04 and adjusted earnings per share of approximately $0.09 to $0.15. Consistent with our 2025 performance, our quarterly outlook for adjusted EBITDA is largely informed by normal top line cadence and the timing of R&D spend. As a reminder, 2025 R&D spending included LeAAPS enrollment costs for the first half of 2025 only. Therefore, we expect a slightly higher increase in R&D spending in the second half of 2026. In conclusion, our first quarter results highlight the durability of AtriCure innovation and continued improvement in our financial profile while funding investments in growth catalysts for the future. We remain energized by the opportunities in front of us and the exceptional AtriCure team who will make 2026 a success. With that, I will turn the call back to Mike.

Michael H. Carrel, President and Chief Executive Officer

Thanks, Angie. 2026 is off to a good start, and our team is fully committed to our patients, our partners and our shareholders. As we look ahead, we are confident in our ability to execute with discipline, sustain operational excellence and build on the momentum that we've created, delivering meaningful progress throughout 2026 and well beyond. And with that, I'll turn it over to the operator for any questions. Operator?

Operator, Operator

And our first question comes from Bill Plovanic with Canaccord Genuity.

Zachary Day, Analyst (Canaccord Genuity)

This is Zachary. Can you talk about the progress you're making on PFA integration? Any milestones that we should be on the lookout for this year? And then can you talk quickly about the RF enhancements you're making to come with the next-generation catheter?

Michael H. Carrel, President and Chief Executive Officer

Sure. I'll take that on. I appreciate the question. On the PFA, we're making great progress on that. We've done our first in-human over in Australia so far. We're now starting first in-human in Europe as well. It's not really first in-human anymore, but we're going to be doing an additional 30 to 40 patients in Europe. And so that will obviously lead for our submission for the trial that we expect to start running sometime next year. And so we're on pace, doing great. No additional commentary at this point in time, but we're really pleased with the results that we've seen so far and feel like there aren't any specific milestones other than submission to the FDA later on this year, acceptance of the IDE and then beginning to enroll as we kind of look into 2027 at some point in time. So we'll give more details as we kind of get forward on that. We really want to focus today's effort on, obviously, the great progress we've made on the BoxX-NoAF clinical trial because we're so far ahead of plan that we wanted to make sure that we got that out there. 300 patients in a very short period of time put us well over a year ahead of plan, and we thought that was just a big, big milestone for us as we kind of close out this year being able to finish up enrollment around the end of the year. That's something we're super excited about. As for the RF advancements, they are embedded in there. We've got both the RF and also the dual energy combined in some of those first-in-human playbooks, and that will all be indicated and looking forward to kind of seeing that in trials sometime next year.

Operator, Operator

Our next question comes from Matthew O'Brien with Piper Sandler.

Matthew O'Brien, Analyst (Piper Sandler)

The first one, Mike, I know you can't grow this pain management business 30% every quarter but just talk about what you saw in the quarter from a growth perspective in terms of new accounts, existing accounts with cryoSPHERE MAX? And then also on the ortho side of things, just maybe the contributions that you got from those different buckets and how do we think about the growth trajectory for that business? And then I do have a follow-up.

Michael H. Carrel, President and Chief Executive Officer

Yes. I'll start and just say that the cryo business, the pain business, is as we talked about at our Analyst Day about a year ago, this is something that's got multiple billions of dollars of opportunity. Obviously, thoracic is an area that we've been established in for a long period of time. We're now starting to see some traction on the sternotomy side, and we're just starting on this, below-the-knee amputation area. We're just scratching the surface in all the areas that people undergo surgery and have a lot of pain afterwards, both from other parts of the body and other types of surgeries to looking into and researching the impact that you can have on phantom limb pain, which affects over 3 million people. These are large numbers when you look at it. So we've got decades worth of growth in my mind here. Whether or not we can grow 30% for decades, obviously, the numbers get bigger and that becomes more difficult. But the good news is we've got multiple places to actually grow this market for many, many years to come. And with that, I'll turn it over to Angie to give you some of the specifics on the numbers.

Angela Wirick, Chief Financial Officer

Yes. Matt, from an account perspective, about 70% of our pain management accounts have adopted cryoSPHERE MAX, and we continue to see every quarter since we've launched that we see nice uptake. It was about 10% growth in the cryoSPHERE MAX accounts within the quarter. So this is clearly becoming the dominant device that's being used. I think surgeons are very compelled by the quick freeze times that they're seeing and just exceptional outcomes for their patients.

Matthew O'Brien, Analyst (Piper Sandler)

Got it. That's great to hear. On BoxX-NoAF, in my experience, Mike or Angie, when these things enroll faster, it's because doctors are seeing good outcomes. That's why they're doing more of these cases. Can you just talk about any kind of anecdotal feedback you're getting from the clinicians as far as outcomes here? And then kind of what's expected from these outcomes? And then given the timeline for finishing enrollment, could we see—because I think the follow-up is pretty short—could we see data at ACC or HRS next year?

Michael H. Carrel, President and Chief Executive Officer

Yes. Great question. I think you're right that that is often what drives faster enrollment. We don't have any specific unblinded data to share because it's a randomized blinded trial. I don't know the specific randomization for individual patients. That being said, we do know sites that have utilized this technology outside the trial and in preliminary work that went into the trial, and what we saw was significant reductions as a result of that. So much in fact that we have several sites—five-plus sites or so—that have decided to adopt this and will not come into the trial because they're seeing such good results using the EnCompass clamp plus the AtriClip to see significant reductions. If you look at the STS database, about 35% to 40% of all patients that undergo cardiac surgery go into postoperative Afib, and in some studies you'll see up to 50%. In other smaller studies, it's less than 10% depending on the approach. We don't need that extreme to demonstrate meaningful clinical impact in the trial. We feel really confident and good about where this is going and the results we'll likely see. In terms of timing of results, you're correct. We think we'll complete enrollment around the end of the year based on the pace of enrollment right now. I said around because it could be late December or early January that we might have full enrollment. Then there's 30 days of follow-up from that last patient and then adjudication. So if you start to do the math, probably not HRS—more likely a surgical congress where we would pursue a late breaker. The surgical congress that would accept that late is AATS next year. If we got the data earlier, STS is in the January–February time frame, although that's unlikely. We're hopeful we can conclude the trial, get the initial results, and get some data out there as a late breaker sometime at AATS, which is around the same time as HRS next year.

Operator, Operator

Our next question comes from Marie Thibault with BTIG.

Marie Thibault, Analyst (BTIG)

I wanted to spend a minute here on your international business. I think you called out some uncertainty on the U.K. side, which I know isn't brand new and also some lower distributor sales from APAC. So can you tell us a little bit more about what's going on behind the scenes there? And any visibility on when things might start to improve? And then it sounds like the direct markets, OUS have been healthy. So just any more color on those markets as well?

Angela Wirick, Chief Financial Officer

Yes. Marie, you called out the two headwinds we're facing within our international business. The U.K. within Europe we had anticipated being a drag and talked at length within our guidance that we've baked in a run rate that looks very similar to how we exited 2025. That held true for the first quarter of 2026 as we started the year. And then with our larger distributors in Asia, inherently, distributor orders can be lumpy. We expect that pressure to be transient as we think about the rest of 2026. Outside the headwinds, we saw really good growth in our franchises in our direct markets in Europe, Australia and Canada. We continue to be excited about bringing new products into each of those markets and seeing the progress the teams are making there. We continue to focus on the NHS and making sure that our pain management device and other efforts address budgetary pressures so we can get this market to a rebound. Our guidance does not assume any kind of recovery in the U.K. and assumes the distributor weakness in Asia is transient.

Marie Thibault, Analyst (BTIG)

Okay. Great detail. And then maybe my follow-up on the Convergent procedure side, just wanted to understand kind of how your view of that market has been evolving. Obviously, the PFA landscape has evolved quickly. So would just love an update on what you're seeing there on the ground.

Michael H. Carrel, President and Chief Executive Officer

Yes. On the ground, we continue to see headwinds in that area. The underlying data for Convergent is still strong and these patients benefit from using the Convergent platform. That said, many patients are trying multiple PFA catheters first—sometimes up to three—before moving to the hybrid pipeline. That delays the pipeline and those patients coming through to Convergent. That's why it's tough to predict exact timing for us. If you talk to most people using Convergent, they still believe in it; they're just seeing fewer patients or trying additional catheter attempts before referring on. That's the reality right now and explains our expectations, but we feel the technology provides meaningful benefit and we will continue to support it.

Operator, Operator

Our next question comes from Lily Lozada with JPMorgan.

Henry, Analyst (on behalf of Lily Lozada, JPMorgan)

This is Henry on for Lily. I just wanted to pivot a little bit to talk about the guidance. You were able to beat on the top line but you reiterated the revenue guide. Can you talk a little bit more about why that's not flowing through into the full year guide? And are there any headwinds in particular you'd like to call out for the remainder of 2026?

Angela Wirick, Chief Financial Officer

Yes. On the top line guide, we came in ahead of our expectations in the quarter, both top and bottom line, which is a positive start to the year, but it is still early and we want to see continued outperformance before we revisit the guidance. That is in line with our philosophy of guiding to numbers we feel very confident in and then outperforming. The headwinds we touched on are primarily within our international business and in our hybrid ablation business in the U.S. The areas of outperformance are the pain management, open ablation and appendage management franchises, and we expect continued strength there.

Operator, Operator

Our next question comes from Mike Matson with Needham.

Joseph Conway, Analyst (on behalf of Mike Matson, Needham)

This is Joseph on for Mike. Maybe just one on international first, China and Japan. I was wondering if you guys could just maybe give a broad overview on where you are now with the portfolio in terms of approvals or launches and maybe where that portfolio could sit in China and Japan by the end of this year?

Angela Wirick, Chief Financial Officer

Yes. Pretty comparable between both our China and Japan markets. You have the basic RF ablation devices. Neither market has EnCompass at this point in time. We just recently put AtriClip in China, so that's a newer product launch in that market. Within Japan, we've had different versions of AtriClip on market and got expanded clearances for the mini devices more recently there and are working on other product launches. With any market expansion you're looking at the product set and what the market can absorb given economic considerations. It is a subset of the overall products that we sell in the U.S.

Joseph Conway, Analyst (Needham)

Okay. Great. Makes sense. And then one on appendage management. So obviously, a very strong year in 2025 and with new products, it's looking good as well. But with the increased competition, it's just trying to get a handle on basically where they are, where your competitors are with trialing and incentives. Has that kind of steadied off? Are you seeing increased incentives for them to trial the product from your customers? Just trying to understand how these new entrants are affecting your sales or not affecting.

Michael H. Carrel, President and Chief Executive Officer

Right now, there's one major entrant in the market, Medtronic, with a competing product. We saw their market share peak in the late summer/early fall timeframe, and since then FLEX-Mini adoption has increased and we've been gaining share back. We still have the predominant market share in the U.S. and feel the innovation of FLEX-Mini and PRO-Mini, plus the clinical evidence we're building, positions us well. Edwards has mentioned plans to enter the market later this year; we will be ready. Our strategy is to build best-in-class products that meet surgeon needs and invest in product-specific clinical evidence. The LeAAPS and BoxX trials are unique to our devices and none of the competition has started trials of this nature—these are long trials—so that provides a competitive advantage. Competition entering the market is a sign it's a large market; multiple players are normal in medical devices. That indicates a multibillion-dollar opportunity and is a positive signal for the sector.

Operator, Operator

Our next question comes from John McAulay with Stifel.

John McAulay, Analyst (Stifel)

Just want to put a finer point on the 2026 guidance commentary you gave. So reiterating the top line range and adjusted EBITDA range. I just want to understand the intention there as you beat on both. Would you expect that we let numbers for the rest of the year sort of stay where they are to reflect the strength in the quarter or the hybrid and international headwinds you called out, you expect that those sort of offset the $2 million of upside as we look ahead to the rest of '26?

Angela Wirick, Chief Financial Officer

John, our philosophy is to guide to numbers we can meet and ideally beat. With one quarter in, we're still early in the year and felt prudent to hold the guide. On the bottom line, the accelerated pace of enrollment on BoxX-NoAF brings incremental costs—pulling enrollment in by a year into 2026—that is incremental to our plan. We had a very strong gross margin in the first quarter and expect modest improvement over 2025, but some of that favorability is transient, particularly given international mix. Taking that calculus together with discipline across the business positions us to absorb the additional trial costs and hold the bottom line guide where it is. We believe the numbers we're guiding to are achievable and that we can outperform.

Operator, Operator

Our next question comes from Danny Stauder with Citizens.

Daniel Stauder, Analyst (Citizens)

Just first one on pain management. Great to see the strong quarter. You noted improved market penetration in thoracic and sternotomy. But just on the latter of the two, it's nice to hear you're starting to see traction. But I was just curious what was driving this of late. We've talked about sternotomy and that opportunity for a bit now. So I just wanted to see if there was any newer development that's leading to this?

Michael H. Carrel, President and Chief Executive Officer

Great question. What you're seeing is that the MAX product reduced freeze time roughly in half, which has improved adoption and surgeons' willingness to try it in sternotomy cases. Once they try it and see good results, adoption becomes sticky. This is not likely to be a single hockey-stick moment, but we expect continued robust growth as more accounts adopt it. The user experience and peer-to-peer discussion at trade shows and other forums are driving new account adoption.

Daniel Stauder, Analyst (Citizens)

Okay. Great. And then just one follow-up on the STS quality metric update. Could you give us a little more color on this? First, when will it start? And should we be thinking of this more as a longer tail growth over the next few years versus more near-term uptick? Just any more information on how we should think about this in terms of incremental adoption or frame the potential revenue opportunity would be really helpful.

Michael H. Carrel, President and Chief Executive Officer

Sure. A reminder that in the U.S., about 35% of patients who have Afib and undergo cardiac surgery actually get an ablation, so there is substantial upside. The STS announced concomitant Afib treatment as a quality metric and put a 70% target in their commentary. They anticipate rolling this out with more enforcement in 2027, at which point it will be measured and recorded in the STS database; specifics are still being finalized by STS. To give perspective, when LIMA-to-LAD became a quality metric historically, adoption went from about 10% to nearly universal. Quality metrics influence hospital behavior, ratings and incentives. We anticipate an uplift in adoption beginning in 2027 and continuing into 2028 and beyond, which should be a multi-year positive for the ablation side. Combined with the non-Afib trial data and the ease of use of EnCompass, we expect meaningful adoption increases over the next three to five years.

Operator, Operator

Our next question comes from Keith Hinton with Freedom Capital Markets.

Keith Hinton, Analyst (Freedom Capital Markets)

I just have a quick one on AtriClip. Can you just talk a little bit—and I apologize if I missed this, I'm jumping around a little bit—but can you talk a little bit about the use of FLEX-Mini versus the prior generations in open appendage? And then more broadly, can you just talk about the current ASP for AtriClip in the U.S. and how we should think about those dynamics going forward as uptake continues for FLEX and PRO-Mini?

Angela Wirick, Chief Financial Officer

Yes, I'll take this one. The AtriClip FLEX-Mini is seeing a steady conversion from our prior-generation AtriClip FLEX device, and less conversion from the original AtriClip device, which remains on the market. Between the three products there are different price points and surgeons choose based on approach and pricing sensitivity. Exiting Q1 2026, FLEX-Mini represented about 40% of U.S. open appendage management revenue, up from a little over 35% at the end of last year. We continue to see steady share gains following that new product launch. From an ASP perspective, our range is approximately $1,100 for the original AtriClip device up to about $2,250 for the FLEX-Mini clip.

Operator, Operator

Our next question comes from Suraj Kalia with Oppenheimer & Co. Suraj your lines are open, please unmute your button. I am showing no further questions at this time. I would now like to turn it back to Mike Carrel for closing remarks.

Michael H. Carrel, President and Chief Executive Officer

Great. Well, I just wanted to thank everybody for joining the call today after an exciting Q1 and what's starting to be a great 2026 overall. So thank you for joining. We appreciate it. We look forward to talking to you again in July. Talk to you soon.

Operator, Operator

This concludes the question-and-answer session. This concludes today's conference call as well. Thank you for participating. You may now disconnect.