AtriCure (NASDAQ:ATRC) President and CEO Mike Carrel outlined the company’s strategy and growth outlook during a presentation and Q&A at a JPMorgan event in San Francisco, emphasizing what he described as a large market opportunity across atrial fibrillation (AFib) treatment and post-surgical pain management.
Focus areas: AFib and pain after surgery
Carrel said AtriCure is focused on reducing the global burden of AFib and pain after surgery. He framed the company’s portfolio as addressing what he called a potential $10 billion annual opportunity across the products it has today and markets that could expand with additional clinical evidence and broader adoption.
AFib: targeting the most complex patients and expanding cardiac surgery penetration
Carrel described AFib as a large and growing market, citing nearly 60 million patients globally, up from roughly 30 million when he joined the company 13 years ago. He said AtriCure targets complex disease, focusing on patients with AFib lasting more than one year, which he said represents about 45% of AFib patients.
He emphasized the clinical risks associated with AFib—such as higher likelihood of stroke and heart failure—and referenced studies linking earlier-onset AFib with a greater chance of dementia. Carrel also cited reports suggesting five-year survival after an AFib diagnosis is worse than about two-thirds of cancers, underscoring his view that keeping patients in sinus rhythm is a critical objective.
Within cardiac surgery, Carrel said AtriCure’s goal is for “every patient that undergoes cardiac surgery” to receive an ablation and an AtriClip device. He estimated the company is less than 10% penetrated globally in this opportunity. Historically, AtriCure focused on cardiac surgery patients who already had AFib, but Carrel said the company now views postoperative AFib as a major market driver, noting patients undergoing cardiac surgery have a 35%–40% chance of developing post-op AFib.
Carrel pegged the cardiac surgery market at roughly 2 million patients, and he described the annual opportunity as over $7 billion when applying AtriCure pricing assumptions and “discounting.” He attributed recent growth in open ablation to product innovation—specifically the EnCompass Clamp, designed to make the procedure easier to perform broadly. He said open ablation growth accelerated from mid-single digits historically to “high teens, if not more” over the last five years.
Clinical evidence and trials aimed at “standard of care” shifts
Carrel said AtriCure is investing in clinical evidence to drive guideline changes, reimbursement, and adoption. He pointed to shifts in guidelines, describing “level one” guideline support for much of what the company does in open cardiac surgery.
He also discussed reimbursement impacts and said evidence previously generated led to higher CMS payments. He cited examples including CMS willingness to pay over $10,000 in additional reimbursement for certain CABG scenarios and “almost $24,000 additional” for a double valve procedure, along with added physician payment.
Carrel highlighted two randomized controlled trials intended to expand AtriCure’s addressable market in cardiac surgery:
- LeAAPS: Carrel called this the largest trial ever done in cardiac surgery. It randomizes patients without AFib to receive an AtriClip or not, with stroke outcomes tracked over five years. He said enrollment finished two years ahead of plan and that events appear to be accruing faster than expected, though he did not provide a specific timeline for readout.
- BOX-NO-AF: Initiated in the fourth quarter, this 960-patient randomized trial is designed to evaluate whether using the EnCompass Clamp plus clip in patients without AFib can reduce postoperative AFib. Carrel said the study can enroll at up to 75 sites and is already ahead of plan on enrollment.
Carrel said AtriCure believes combining evidence of stroke reduction (LeAAPS) with evidence of lower post-op AFib rates (BOX-NO-AF) could support a future where ablation plus clip becomes routine for cardiac surgery patients. He added that this would be a “market expansion” opportunity without requiring a new sales force, since AtriCure already has relationships and call points in the relevant hospitals.
Pain management: cryo nerve block growth and expansion into amputations
Carrel described pain after invasive surgery as a persistent issue affecting recovery, opioid use, and healthcare costs. He said cryoanalgesia can provide pain relief lasting from six weeks up to three months, reducing opioid use and potentially improving recovery. He cited a company study in thoracotomy showing potential savings of $8,000 to $15,000 during recovery, attributed to fewer urgent care visits and other downstream needs.
He estimated the pain management opportunity at over $2 billion in the areas AtriCure targets today—thoracotomy, sternotomy, and amputations—and called it the company’s fastest-growing segment. He highlighted product innovation including cryoSPHERE MAX, which reduced freeze time per nerve from two minutes to 60 seconds, and a newer product, Cryo XT, intended for extremity procedures including amputations.
Discussing amputations, Carrel cited about 180,000 amputations annually in the U.S. and said AtriCure’s initial target is 100,000 below-the-knee amputations, often involving diabetic patients. He said freezing nerves during these procedures could enable patients to go home on post-op day one rather than staying four or five days and may reduce opioid use and possibly “phantom limb pain,” which he described as severe and long lasting.
Financial performance, guidance, and segment dynamics
Carrel said AtriCure delivered 15% overall growth and an 86% increase in positive EBITDA, and he cited updated adjusted EBITDA expectations of $57–$59 million and $44 million in cash generation for the year discussed. Looking ahead, he said the company is guiding to 12%–14% growth and adjusted EBITDA of $80–$82 million, and he stated AtriCure expects to generate net income for the first time in 2026 and to generate cash for the full year.
In Q&A, Carrel said fourth-quarter performance was strong, driven by “exceptional” cryo nerve block growth and “excellent” growth in open ablation and open clip, with EnCompass adoption cited as a factor. He noted a specific international headwind in the U.K., where budget pressure led to delayed or canceled procedures, impacting cryo nerve block results; he said 2026 guidance assumes this pressure does not reverse.
Carrel also addressed ongoing weakness in the company’s hybrid AFib therapy business, saying performance remained pressured, though he noted a sequential uptick from Q3 to Q4 in revenue and number of ordering accounts, which he characterized as an early positive sign while stopping short of declaring a bottom.
On cadence, he said the year could skew toward the lower end of guidance early and the higher end later, with cryo expected to ramp more as Cryo XT gains traction and Flex Mini adoption expands. He said most of the recent growth in AtriClip was driven by volume rather than price and noted Flex Mini was only in about a third of accounts so far.
Carrel attributed improved profitability expectations to operating leverage, including reduced R&D burden following completion of LeAAPS enrollment, with BOX-NO-AF described as a large but smaller trial, and SG&A discipline. On cash generation, he said the company plans to continue strengthening its balance sheet while maintaining investment as a growth company.
About AtriCure (NASDAQ:ATRC)
AtriCure, Inc is a medical device company focused on the development, manufacture and marketing of innovative therapies to treat atrial fibrillation (AF) and related conditions. Founded in 2000 and headquartered in Mason, Ohio, AtriCure has established itself as a leader in surgical ablation devices designed to interrupt the errant electrical pathways that cause AF. The company’s solutions are used by cardiac surgeons and electrophysiologists to reduce the risk of stroke and improve patient outcomes in the treatment of both paroxysmal and persistent AF.
The company’s product portfolio centers on its Synergy Surgical Ablation System, which delivers controlled radiofrequency energy in a minimally invasive format, and the cryoICE Cryoablation System, which offers an alternative ablation modality using precise freezing techniques.
