NYSEAMERICAN:STXS Stereotaxis Q4 2023 Earnings Report $2.00 -0.02 (-0.74%) As of 03:14 PM Eastern This is a fair market value price provided by Polygon.io. Learn more. Earnings History Stereotaxis EPS ResultsActual EPS-$0.07Consensus EPS -$0.07Beat/MissMet ExpectationsOne Year Ago EPSN/AStereotaxis Revenue ResultsActual Revenue$4.57 millionExpected Revenue$7.55 millionBeat/MissMissed by -$2.98 millionYoY Revenue GrowthN/AStereotaxis Announcement DetailsQuarterQ4 2023Date3/4/2024TimeN/AConference Call DateMonday, March 4, 2024Conference Call Time4:30PM ETUpcoming EarningsStereotaxis' Q1 2025 earnings is scheduled for Monday, May 12, 2025, with a conference call scheduled at 4:30 PM ET. Check back for transcripts, audio, and key financial metrics as they become available.Q1 2025 Earnings ReportConference Call ResourcesConference Call AudioConference Call TranscriptPress Release (8-K)Annual Report (10-K)Earnings HistoryCompany ProfilePowered by Stereotaxis Q4 2023 Earnings Call TranscriptProvided by QuartrMarch 4, 2024 ShareLink copied to clipboard.There are 7 speakers on the call. Operator00:00:00Good afternoon. Thanks for joining us for Stereotaxis 4th quarter and full year 2023 earnings conference call. Certain statements during the conference call and question and answer period to follow may relate to future events. Expectations and as such constitute forward looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements involve known and unknown risks, uncertainties and other factors, which may cause the actual results, performance or achievements of the company in the future to be materially different from the statements that the company's executives may make today. Operator00:00:43These risks are described in detail in our public filings with the Securities and Exchange Commission, including our latest periodic report on Form 10 ks or 10 Q. We assume no duty to update these statements. At this time, all participants have been placed on a listen only mode. The floor will be opened for your questions and comments following the presentation. As a reminder, today's call is being recorded. Operator00:01:15It is now my pleasure to turn the floor over to your host, David Fischel, Chairman and CEO of Stereotaxis. Speaker 100:01:24Thank you, operator, and good afternoon, everyone. It's a very exciting, productive, busy, challenging and promising period for Stereotaxis. We are glad to be entering this year having made significant progress towards realizing our strategic transformation. Given where we stand, we have high confidence in the key puzzle pieces of this strategy coming together in the coming months, putting Stereotaxis on a solid strategic foundation and providing line of sight to when commercial breakouts are possible. We are driving this progress against the backdrop of various challenges, which highlight the merit of our strategy. Speaker 100:02:07It is always helpful to view one's position in a broader context. This being our annual call, I want to use the occasion to step back and provide that perspective. I'll then share specific updates on our innovation and commercial efforts. Kim will then provide details on our financial results and we will open the line to questions. Stereotaxis' overarching mission is to improve minimally invasive endovascular surgery with the precision, safety and unique capabilities of robotics. Speaker 100:02:41We are the pioneer and global leader in endovascular robotics and have demonstrated the clinical relevance and value of our technology in robust real world use at over 100 hospitals that have treated 150,000 patients. Despite having pioneered a highly differentiated and advanced technology that works reliably in the real world and provides meaningful clinical value, Stereotaxis has a long history of commercial struggles. After joining Stereotaxis, I recognized that these struggles could be traced to structural weaknesses with our product ecosystem. These weaknesses put Stereotaxis in a challenging position with commercial disadvantages and strategic dependencies and made adoption of robotics very difficult even for our strongest advocates. We identified 3 key structural issues. Speaker 100:03:39First, in our core existing market, electrophysiology cardiac ablation procedures for the treatment of arrhythmias, we built our business dependent on Johnson and Johnson. We were only integrated with their diagnostic mapping system and they manufacture the ablation catheter used in every one of our procedures. That dependency limited the ability for patients and physicians to benefit from continuous innovation, created commercial challenges and provided Johnson and Johnson rather than Stereotaxis with the majority of economic value from every robotic procedure. 2nd, installing our robotic system in a cath lab is a significant construction process, requiring architectural planning, room shielding and reinforcement, special electrical work and hiring contractors, which all add complexity, time, effort and expense. This process leads to very long sales cycles and a high bar for adoption. Speaker 100:04:39The vast majority of interested potential customers ultimately never succeed in getting a system. 3rd, while Stereotaxis' robotic technology is designed as a platform technology enabling the treatment of a broad spectrum of complex endovascular procedures, the company did not offer the interventional tools to allow for this expansion of indications. Being limited to one specific procedure as large and attractive as the cardiac ablation market is doesn't provide for healthy diversification and full appreciation of our opportunity. Being clear eyed and intellectually honest was the first step in improvement. We worked hard over the subsequent years to formulate a comprehensive and elegant strategy to address these weaknesses. Speaker 100:05:30The strategy was creative and required significant innovation, but was realistic for us to accomplish while controlling technological and financial risk. It was attractive in providing strategic independence and opportunity for substantial commercial breakout. Most importantly, it fundamentally improves and broadens our product offering for the patients, physicians and hospitals that rely on us. Stereotaxis has advanced this comprehensive innovation strategy over several years through the development process. 2024 is the year in which we expect all the key puzzle pieces to come together, setting us up with multiple shots on goal for breakout growth in 2025. Speaker 100:06:18A few updates on the key innovation efforts follow. In our existing cardiac ablation market, our key effort has been to address our strategic dependency, develop a proprietary ablation catheter and create an open ecosystem around our robot. We were delighted today to announce initial clinical results and regulatory submissions for the MAGIC catheter, our proprietary advanced robotically navigated ablation catheter. Following our earnings call last November, we received approvals to initiate a human clinical trial of MAGIC in both Lithuania and Denmark. Julius University in Lithuania enrolled its first patient at the start of this year and completed enrollment of the 20th patient in January. Speaker 100:07:08The results from these initial procedures were stellar and were summarized by the physicians in a manuscript recently submitted for publication in a prominent electrophysiology journal. Across these 20 patients ranging in age from young adults to the elderly and suffering a range of arrhythmias, there was 100% acute success in treating the arrhythmias and no adverse events or device or procedure related safety events. Additional patients beyond these 20 have been treated in both Lithuania and Denmark with consistent positive results. Beyond the stellar clinical outcomes, qualitative commentary from all the physicians who participated in the trial was very positive, reinforcing our confidence in the impact MAGIC will have on patients and physicians. We resubmitted the MAGIC catheter to the European notified body and believe the data fully addresses the request made last summer where we were told clinical data would be necessary to be granted CE Mark under the more rigorous MDR requirements. Speaker 100:08:12We also submitted the MAGIC catheter for U. S. Regulatory approval as a PMA supplement to the FDA. The clinical data adds to a substantial body of bench, preclinical and published clinical literature supporting the value of robotic cardiac ablation generally and the safety and effectiveness of MAGIC specifically. While there is always uncertainty with any regulatory submission, we believe we made strong submissions and have received feedback to that effect from experts in our field. Speaker 100:08:44We look forward to working collaboratively with the regulatory bodies in the coming months to ensure the MAGIC catheter becomes available for the patients and physicians who depend on it. The launch of MAGIC will benefit from our strong collaboration with Abbott and last year's successful launch of mapping integration with Abbott's N Sight X mapping system. We are seeing continued expansion in the adoption of our integrated technologies in both the U. S. And Europe. Speaker 100:09:15This is a significant strategic collaboration in its early phases and we are delighted with how The second major initiative in our innovation strategy was to address the challenges and complexities of adopting robotics. We developed a smaller self shielding robot that significantly enhances its accessibility by removing the requirement for cath lab construction. We discussed on the last call our balanced approach to the timing of a regulatory submission such that approval of the robot aligns approximately with market availability of Magic. The robot has gone through design freeze and now begun formal testing. We are confident in regulatory submissions in both the United States and Europe in the Q2 and expect regulatory clearance in Europe mid year. Speaker 100:10:11Our experience selling Genesis gives us daily visibility into the timeline shifts and hospital construction delays that slow adoption, even at sites that are most motivated to build a robotic program. This experience reinforces our confidence that the availability of a smaller and more accessible robot, something that can be installed without construction, will serve as a significant structural improvement to the pace and scale of adoption. Following approval, we plan to use the current year to demonstrate the reality of the robot in real world use, enhance compatibility of the robot with various X rays and prepare our supply chain manufacturing, installation and commercial processes for a full launch in 2025. Our 3rd strategic innovation effort is development of a family of interventional guide wires and guide catheters that expand the benefits of our robots into new endovascular indications with 5 specific multibillion dollar opportunities being targeted: neurointerventions, coronary angioplasty, peripheral interventions, tumor embolization and AAA grafts. The first Guidewire is fully designed with our contract manufacturer, we've been grinding through the challenges of establishing high quality and robust manufacturing processes. Speaker 100:11:38We expect to complete the manufacturing and testing of the significant number of guide wires necessary for a regulatory submission in the middle of this year and still expect commercial availability of the guide wire late in the year. Once we have made regulatory submissions, we will host an innovation day to allow several key physicians from multiple specialties to share their perspective and experience with where our robotic technology can add critical value in the broader field of endovascular surgery. These three innovations, the MAGIC catheter, newer mobile robot and endovascular devices are our strategic response to the 3 structural limitations described earlier. We have line of sight to them attaining key regulatory approvals and commencing commercialization in 20 24 with growing commercial impact in 2025. Beyond these big three innovations, we were fortunate to nurture 2 additional opportunistic growth drivers that are synergistic and additive to our core effort. Speaker 100:12:45In China, we entered into a strategic collaboration with MicroPort to establish a China specific EP product ecosystem. MicroPort recently submitted to China's NMPA regulatory body, the robotically navigated ablation catheter we developed together. We have completed mapping integration with their Columbus mapping system and Genasys is expected to receive Chinese regulatory approval mid year. As this core product ecosystem is available, we expect to benefit from MicroPorts' substantial commercial footprint already servicing hundreds of hospitals. Our second synergistic and opportunistic venture is a digital surgery platform that enables broad operating room connectivity, both alongside our robotic platform and independently in non robotic been released internally for our team in preparation for an external release. Speaker 100:13:46We are still finalizing remaining hardware, firmware and software efforts with the Synchrony integrated display capability, but expect to begin formal regulatory testing in the Q2 followed by submissions in summer. We will continue a soft launch of SYNC till then, but plan for a full launch of Synchrony and SYNC as a combined solution enabling streamlined workflow, connectivity and collaboration broadly in any operating room. The Synchrony hardware will provide an incremental upfront capital sales opportunity, while Sync will be available with a freemium SaaS business model with premium subscriptions for hospitals, medical device sales forces and physician users. I recognize our progress has taken longer than expected and faced unforeseen challenges With key regulatory submissions and technology developments done, we see the puzzle pieces falling into place this year. While there is risk and uncertainty with any regulatory process, our strategy is de risked with multiple shots on goal. Speaker 100:14:53In each of our 3 key geographies, the United States, Europe and China, we have the opportunity for a full ecosystem coming together and driving breakout growth. The opportunity in any individual geography can dwarf our current entire business. We are driving this innovation transformation while working hard to ensure our commercial momentum and financial strength are preserved. We continue to see signs of commercial progress with positive feedback and utilization of Genesis as well as capital interest in Genesis from both existing users and completely new customers. In the Q4, we were excited to receive a Genesis order from a greenfield hospital in Germany. Speaker 100:15:41Germany as a country was one of the most enthusiastic earliest adopters of the first Niobe system and then also unfortunately the region with the strongest backlash for robotics given that the first Niobe systems were launched prematurely. To see our installed base grow with new physician users in Germany is particularly encouraging given that historical context. The order represented our 12th greenfield robotic order globally since the launch of Genesis and our 24th order overall. We begin 2024 with $14,700,000 in backlog from orders that were received, but not yet shipped or installed. While we continue to see a healthy pipeline of greenfield and replacement cycle customers for Genesis, overall progress is slow. Speaker 100:16:34Beyond the well understood challenges of closing a substantial capital sale for a system that requires hospital construction, several electrophysiologists have expressed their concern with the recurring catheter shortages of Johnson and Johnson and the awareness of the dependency on J and J catheters in absence of our own magic catheter as a replacement. While this has not deterred some hospitals from moving forward, it serves as an additional risk item that extends due diligence and delays purchase decisions. We believe our regulatory submissions of MAGIC will partially help and then obviously receipt of approvals will address this concern. Despite this pressure, we expect the continued pace of robotic system orders and sales with expected growth for both in 2024 compared to 2023. Our recurring revenue was also impacted by the catheter shortage from J and J, which impacted procedure volumes as well as the loss of royalty payments from J and J, which created a $2,000,000 headwind to both our top and bottom line results. Speaker 100:17:39We continue to see inconsistent availability of the J and J catheter flare up in various geographies and accounts, but expect overall recurring revenue in 2024 to be consistent with 2023. Our burn rate in 2023 was lower than 2022 despite these revenue challenges. So the absolute burn rate was still higher than what we expected. Our balance sheet remains strong with approximately $20,000,000 cash and no debt. We are cognizant of the importance of financial prudence and are confident our existing balance sheet allows us to advance our transformative product ecosystem to market and fund its commercialization. Speaker 100:18:24We have already invested in significant inventory and have direct commercial teams globally that are well suited to launch the new products as they become available. We expect a lower burn rate in 2024 compared to 2023, driven by increased Genesis robotic revenue and reduced cash outflows as some of the most significant R and D spending is behind us and we taper inventory purchasing. Kim will now provide additional commentary on our financial results and then I will make a few financial comments as well before opening the call to Q and A. Kim? Speaker 200:19:00Thank you, David, and good afternoon, everyone. Revenue for the Q4 of 2023 totaled $4,600,000 compared to $7,300,000 in the prior year Q4. System revenue was $100,000 and recurring revenue was $4,500,000 compared to $2,200,000 $5,100,000 dollars in the prior year Q4. System revenue was abnormally weak due to delays in hospital construction schedules and no shipments being made as a result. Recurring revenue was in line with recent quarters, but below the prior year level due to Stereotaxis no longer receiving royalty payments from Johnson and Johnson. Speaker 200:19:44Revenue for the full year 2023 totaled $26,800,000 compared to $28,100,000 in 2022. Full year system revenue was $8,700,000 compared to $6,800,000 in the prior year, reflecting increased system deliveries and installation. We started 2024 with system backlog of 14,700,000 revenue was $18,000,000 compared to $21,300,000 reflecting the continued absence of the J and J royalties and periodic catheter shortages by Johnson and Johnson. Operator00:20:23Gross margin Speaker 200:20:24for the Q4 and full year 2023 were approximately 60% 56% of revenue. For the full year 2023, we reported gross margins of 79% on recurring revenue and 8% for system revenue. System gross margins continue to reflect relatively low production volume combined with significant allocations of fixed overhead and related expenses. Operating expenses in the 4th quarter were 8,000,000 dollars Excluding $2,600,000 in non cash stock compensation expense, adjusted operating expenses in the current quarter were $5,400,000 compared to prior year adjusted operating expenses of 6,200,000 dollars Adjusted operating expenses for the full year 2023 were $26,200,000 compared to $26,800,000 in the prior year. Operating loss and net loss for the Q4 of 2023 were $5,300,000 $5,000,000 compared to $4,500,000 $4,200,000 in the previous year. Speaker 200:21:40Adjusted operating loss and adjusted net loss for the quarter, excluding non cash stock compensation expense, were $2,700,000 $2,400,000 compared to $1,900,000 $1,600,000 dollars in the previous year. For the full year 2023, adjusted operating loss of $11,300,000 dollars and adjusted net loss of $10,200,000 compared to an adjusted operating loss of $8,300,000 and an adjusted net loss of $7,800,000 in the prior year. Negative free cash flow for the full year 2023 was $9,100,000 compared to 10,800,000 dollars for the full year 2022. At December 31, we had cash and cash equivalents of $20,600,000 and no debt. I will now hand the call back to David. Speaker 100:22:36Thank you, Kim. We are cognizant that accurately guiding revenue has been challenging and there has been significant volatility in quarterly results as any individual robot sales has a significant impact on the quarter. Humbled by that experience, we are providing specific revenue guidance only for this current Q1 of 2024, in which we expect revenue of approximately $7,000,000 Looking at the full year recurring revenue to remain stable until Magic can contribute to disposable revenue growth. We expect continued growth in system revenue through conversion of our $14,700,000 backlog and new system orders, with system revenue growth driving overall double digit revenue for the year. We expect our bolus of innovation to play a decisive role in driving breakout revenue growth in 2025 and beyond. Speaker 100:23:38We will now take your questions. Operator, can you please open the line to Q and A? Operator00:23:44The floor is now open for your questions. Our first question comes from the line of Frank Taconan with Lake Street Capital Markets. Please go ahead. Speaker 300:24:14Great. Thanks for taking the questions. Maybe to start with the magic catheter submissions. On the EU submission, how should we handicap that being a resubmitted file? I assume that there's a little bit more certainty that they'll come back with a clearance on that now that they've had a chance to already review it once and they made their request. Speaker 300:24:33But maybe is there any way to kind of risk adjust that given it's already been looked at once and then 2 on the FDA side. 1 was that submitted and is that a standard 180 day review or how should we think about the process between now and the clearance expectation you put out there? Speaker 100:24:49Hi, Frank. Thanks for the questions. So generally, I want to state that we're not going to give a lot of commentary on regulatory submissions or the review during the review period. Other than that, we think we made strong submissions. And obviously, we're going to work collaboratively with the reviewers over the coming months I look forward to working collaboratively with them. Speaker 100:25:13Your commentary on the EU submission, you're correct. It is a resubmission of the vast, vast majority of the information with just the addition of the clinical data. We are fortunate that the reviewers are the same reviewers that looked at the submission a year ago, and so that should support the review process in a more efficient fashion. There is no statutory time limit of the review. So we are obviously beholden to the notified body and when they're able to review things. Speaker 100:25:54But given the history there and given the multiple discussions that took place last year, we are hopeful and believe it's reasonable to assume that this will be a much more efficient process. And with the U. S. FDA, this is 180 day PMA supplement, and we expect to work collaboratively with FDA during the review process. And it wouldn't be surprising if during that review process, we do kind of have additional questions and discussions with FDA. Speaker 100:26:31So we're not I wouldn't kind of think that necessarily the 180 days is has to be the way it's going to play out. But overall, it is 180 day PMA supplement how quickly Speaker 300:26:45the uptake could occur within the installed base? Maybe thinking about how quickly the uptake could occur within the installed base? Maybe starting with how many procedures you're doing today would be helpful context and then how quickly you can roll that, the MAGIX catheter into your established sites and swap out the old catheter for the new one? Speaker 100:27:08Sure. So we've talked before about doing under 10,000 procedures a year with approximately 40%, 45% of that volume in Europe, 40%, 45% of that volume in the U. S. And about 10%, twenty percent of that volume in Asia. And so that's kind of the overall installed base. Speaker 100:27:30So we have several 1,000 procedures a year each in both Europe and the U. S. U. S. Where in certain geographies, certain countries, certain regions, you do pursue then local tenders after you have CE Mark, while in others, really the only structural barrier is a contract with the hospital and setting a price with the hospital. Speaker 100:28:01And generally, I would expect, given also the fact that we are gaining a real world clinical experience with the catheter currently through the clinical trial, I would expect a relatively quicker ramp in catheter adoption as it becomes available. The things that we have to do in tandem with gaining regulatory approval And then also the work that we're doing with Abbott to convert existing users, which also also be beneficial in accelerating adoption. And so those are the things we think about as we think about adoption, but I overall expect to see a relatively rapid transition over, let's say, a handful of quarters. Speaker 300:29:04Okay. That's helpful. I'll stop there. Thanks for taking the questions. Speaker 100:29:07Thank you. Operator00:29:09Our next question comes from the line of Jason Witte with Roth MKM. Please go ahead. Speaker 400:29:17Hi, thanks for taking the questions and congrats on the submission here. In terms of you just kind of highlighted a little bit, but in terms of this year's outlook, should we expect anything from Magic this year or is it really a 2025 event? Speaker 100:29:34We didn't discuss and thanks for joining us, Jason, and glad to have you on the calls again. We didn't incorporate any revenue from Magic in the commentary we provided in terms of how we generally think about this year's revenue. And that said, it would be surprising if we do not generate some revenue from Magic in the back half of this year. It will really be dependent on the timing of regulatory approval in terms of how much to expect. And so I think until we don't have that approval in hand, it's hard for us to estimate how much to contribute. Speaker 100:30:16But I would definitely expect that we get at least one approval prior to the end of this year with the chance for Magic to start to contribute to recurring revenue. Speaker 400:30:27Okay. That's helpful. Thanks. And also I appreciate the backlog information of $4,700,000 I mean roughly what is the expectation in terms of how long those take to get placed in a hospital? Speaker 100:30:41Sure. So just it is $14,700,000 Speaker 300:30:45Okay. That's yes. Speaker 400:30:47If I say that wrong, apologies. Speaker 100:30:49No, fine. And so overall, we would estimate, and I'm looking at Kim right now, if she wants to correct me, that typically you would estimate that approximately 80% of that will be recognized as revenue and getting a thumbs up. So that seems correct. About 80% of that should be recognized within a given year. We have seen scenarios where hospitals that were planning to take delivery at a specific date, push back that date during due to their own challenges. Speaker 100:31:19And so there is there's not guarantees of that playing out as we've seen even up until the Q4, obviously, in the results of our Q4. But generally, that 80% within 1 year for backlog is a general rule that holds. Speaker 400:31:39Okay. That's helpful. Then last question. Just in terms of supply issues with the current catheter, are there any updates from your supplier? Or is there any change in outlook? Speaker 400:31:50Or how should we be thinking about this for 2024? Speaker 100:31:54Yes. So just to be clear, the catheter shortages are not from a supplier of ours nor from a company that we have any control over. This is all related to the dependency, which I described before, where Johnson and Johnson independently manufactures, sells and supplies the magnetic ablation catheters that are used alongside our robot. And so we do not have control over them or even influence over them in the same way that we would have influence with a supplier that we have hired and worked with. We have seen these crop top over a year ago now, about 1.5 years ago. Speaker 100:32:37We have seen continued shortages that flare up in various specific geographies, various accounts. And there is a randomness to it, though it does definitely pressure the physicians and hospitals that rely on our technology and create disturbances to their normal practices. And so I think given where we stand right now, it seems like the intensity and distribution of those flare ups doesn't seem worse than it was a year ago. And so it seems like overall, the numbers this year should look similar to last year, but there is an aspect of dependency there. And that again speaks to how valuable and important having magic on the market will be. Speaker 400:33:30Great. Thanks. I'll jump back in queue. Speaker 100:33:33Thank you very much, Jason. Operator00:33:36Our next question comes from the line of Alex Nowak with Craig Hallum. Please go ahead. Speaker 500:33:43Okay, great. Good afternoon, everyone. Continuing the manufacturing question there. Just with regards to MAGIC, if you do get the approvals, let's just say second half of this year for both Europe and U. S, how quickly can you ramp up manufacturing? Speaker 100:33:57Hi, Alex. Thanks and good afternoon. So overall, that is something that we've been working with Osypka, our contract manufacturing partner in Germany to improve. They have significant experience manufacturing thousands of units of various interventional devices. And so they have the organizational capabilities to do that. Speaker 100:34:25With every product, there is its own scaling effort. During the formal regulatory testing of Magic, we did produce, I believe it was near 1,000 units of the catheter. So they demonstrate their capability to manufacturing to those to that type of level. We are working with them, have been working with them, we'll continue working with them so that they can scale to the point where we're able to service the entire European and U. S. Speaker 100:34:55Installed base. I think that probably reaching that level still over the course of this year is probably aggressive, but that's what we're shooting for and there are all sorts of incentives in place to increase that manufacturing. Speaker 500:35:15Okay. That is great to hear. Maybe expand on the qualitative commentary with the physicians who are using MAGIC in the European study. Just what do they like about it versus the J and J device specifically? Speaker 100:35:28Sure. So I had the good fortune of being able to actually watch 8 procedures when I visited Vilnius University in January. And I think that kind of obviously, you recognize that the financial, the strategic, the independence benefits of having the catheter, the fact that the catheter serves as the enabling technology for our mobile robot. So all of those are kind of the more strategic aspects from our side. From a clinician's perspective, how does the catheter benefit the patient and the physician? Speaker 100:36:04I'd say that some of the main benefits that were described by the physicians, one was an observation that the stability of the catheter was particularly nice. And we are magnetic catheters are known that one of their key benefits is stability. Oftentimes, that stability is dependent on your approach towards the tissue. And they felt that irrespective of how they approach the tissue with the catheter, they had very, very good stability beyond what typically they considered very good stability with the existing magnetic catheters. So that was one thing that was particularly called out. Speaker 100:36:45The ease of navigation and how that was more intuitive than what they were used to was a second observation that was called out. And then the fact that reduced fluid is required to cool the catheter that should benefit patients that have renal issues or longer procedures that just generally creates reduced fluid load for patients. And so some of those were some of the things that I remember from a visit and from the discussions with physicians. I think kind of those are some of the key, key benefits both for patients and physicians as they switch to MAGIC. Speaker 500:37:25Okay, great. And then just last question, are you teeing up any U. S. Studies just in case the supplement, the FDA comes back and requests additional U. S. Speaker 500:37:35Data? Just how quickly could you turn something like that around? Speaker 100:37:40I believe in the coming months, we will have a much clearer feeling. Coming few months, we'll have a much clearer feeling for the regulatory path in the U. S. Given what we've done in Europe, that has been very helpful in educating us and giving us certain infrastructure to run clinical trials more broadly. And if you step back and think about Stereotaxis as a company, we have a very, very unique and kind of a special capability in terms of building robots. Speaker 100:38:14That's something that almost no other company has. Very few companies have demonstrated the capability to build robots that can actually be deployed in real world clinical setting and can work robustly and reliably there. We have that capability in house. We did not have a historical expertise or experience in developing interventional devices. And that doesn't just mean the engineering aspect, it means the quality, clinical, regulatory aspects related to interventional, intra body devices. Speaker 100:38:51I think that kind of as we've gone through this process, both from a regulatory perspective and now setting up the clinical trial in Europe and all the testing processes that we went through, that all gives us more of an institutional capability in order to replicate those again in the future. And so I think there was definitely a benefit from what we've now demonstrated we're able to pull off in Europe. And depending on how the next few months go, we'll have a feeling on whether it's necessary to start that in the U. S. Speaker 500:39:22Okay, great. I appreciate the update. Thank you. Speaker 100:39:25Thank you very much, Alex. Operator00:39:28Our next question comes from the line of Adam Maeder with Piper Sandler. Please go ahead. Speaker 600:39:35Hi, David and Kim. Thank you for taking the questions here. Wanted to ask a question on the sales force. With the magic launch and the mobile launch coming down the pike here, will you look to build out the sales force to support those launches? Is that a 2025 event or is the plan to kind of push forward with initial infrastructure sorry, the existing infrastructure? Speaker 600:39:59And then I had a follow-up. Thanks. Speaker 100:40:02Hi, Adam. Good afternoon. Thanks for the question. So we have done a small incremental hiring in Europe already late last year, early this year in anticipation of a Magic launch and ensuring that we have the ability to launch Magic across our installed base with the added level of coverage and service that, that would entail. And as discussed in the past, as we launch the catheter initially, we would plan to use our existing sales teams, both in the U. Speaker 100:40:40S. And Europe, to cover those accounts, to launch Magic. They are in all of these accounts. They have the relationships. We have a good team that has good electrophysiology knowledge. Speaker 100:40:53And so they are more than capable of launching the magic catheter in a successful fashion. We would though start to reinvest any proceeds from the catheter back into the sales team so that we grow the team and can gradually evolve to something more like the larger players in the space who oftentimes have 1 or even more than 1 individual per account, per hospital customer. And so I would see us kind of growing that sales team, but we would do it as we're growing the revenue of the magic catheter. Similarly, on the capital side, I would say that we are we know that with any new robotic system, the scaling of supply chain manufacturing and deployment of the robot is a process that takes many months. And even with the new robot that doesn't have the construction requirements, there are still those styles of infrastructure kind of process improvements that play out over a period of months. Speaker 100:41:58And so I'd say that we will probably as we gain approval, we will probably slightly increase the capital sales capability in the relevant geography. And then we'll start to show most of the benefit though from having the robot is that our existing capital sales teams should be able to be much more effective because we've reduced the complexity and time lines related to their sales work. And so as we start to see that playing out, as we start to see the robot being out there in the world, working successfully and well, as we're able to scale our supply chain and manufacturing, And then again, we'll incrementally be building the sales team. And so I think that kind of you'll see most of that type of real mind share and effort in building the commercial team happening in 2025 with some of the preparatory work being done already this year. Speaker 600:42:52That's great color. Appreciate that, David. Thank you. And for the follow-up, I wanted to switch gears and ask about mobile. If I heard correctly, regulatory submissions, both in the U. Speaker 600:43:05S. And Europe for Q2 events. Can you just maybe share what's left to still be done ahead of submission to the regulatory agencies? And just talk about what's informing the confidence there that you'll be able to make healthy submissions and ultimately garner regulatory clearance? Thank you. Speaker 100:43:27Sure. So we are we have the formal the full body of formal regulatory testing that you have to do before you can do a submission. There is still various testing that needs to be done there, most of it done internally with our team. Some of it that is done through external testing services that you have to do through an external testing service. And so that is all expected to play out over the next, let's say, month to couple of months. Speaker 100:44:03And then you have to obviously put together all of the documentation for the submission. And that happens concurrent with testing, but there's always some work after you finish the testing process. Overall, our confidence comes from the fact that we have this is really our expertise, robots. We went through a process very, very similar to this just about 4 years ago, 4, 5 years ago when we submitted the Genesis robot. And so we have the organizational infrastructure, the muscle memory, the documentation that we can leverage for these types of processes. Speaker 100:44:43And we have a skilled team that has run this playbook before, including very recently. So that gives us the confidence. We've had preparatory discussions with regulators. We have clarity on what the regulatory path is. And so that gives us kind of that confidence. Operator00:45:10This concludes today's question and answer session. I would now like to turn the call over to David Fischel for closing remarks. Speaker 100:45:19Okay. Thank you very much for all your thoughtful questions and for your continued support. We look forward to working hard on your behalf this year, bringing about the transformations we promised and speaking again in a couple of months. Thank you. Operator00:45:31This concludes today's call. You may now disconnect.Read morePowered by Conference Call Audio Live Call not available Earnings Conference CallStereotaxis Q4 202300:00 / 00:00Speed:1x1.25x1.5x2x Earnings DocumentsPress Release(8-K)Annual report(10-K) Stereotaxis Earnings HeadlinesStereotaxis to Showcase GenesisX Robotic System at Heart Rhythm Symposium 2025April 23, 2025 | nasdaq.comStereotaxis to Report First Quarter 2025 Financial Results on May 12, 2025April 22, 2025 | globenewswire.comShocking AI play that’s beats Nvidia by a country mileYou’ve seen the headlines about Nvidia. Now Tim Sykes is sounding the alarm — because what CEO Jensen Huang is about to announce could change the AI market once again. Experts already predict the total addressable market could climb past $20 trillion. But Sykes believes most investors have missed what’s coming next. He’s tracking a new shift — and says the biggest gains are still ahead.May 5, 2025 | Timothy Sykes (Ad)Stereotaxis to feature first-ever live demo of GenesisX Robotic SystemApril 21, 2025 | markets.businessinsider.comStereotaxis to Feature First-Ever Live Demo of GenesisX Robotic System at HRS 2025April 21, 2025 | globenewswire.comStereotaxis management to meet virtually with Lake StreetApril 1, 2025 | markets.businessinsider.comSee More Stereotaxis Headlines Get Earnings Announcements in your inboxWant to stay updated on the latest earnings announcements and upcoming reports for companies like Stereotaxis? Sign up for Earnings360's daily newsletter to receive timely earnings updates on Stereotaxis and other key companies, straight to your email. Email Address About StereotaxisStereotaxis (NYSEAMERICAN:STXS) designs, manufactures, and markets robotic systems, instruments, and information systems for the interventional laboratory in the United States and internationally. Its robotic magnetic navigation (RMN) systems include the Genesis RMN and Niobe systems, which enable physicians to complete complex interventional procedures by providing image-guided delivery of catheters and guidewires through the blood vessels and chambers of the heart to treatment sites. The company provides Odyssey, a real-time information solution to manage, control, record, and share procedures across networks; and Stereotaxis Imaging Model S X-ray system, a single-plane, full-power x-ray system, including c-arm, powered table, motorized boom, and monitors for a robotic interventional operating room. In addition, it offers disposables and other accessories, such as QuikCAS automated catheter advancement disposables for the remote advancement of electrophysiology catheters. Further, the company provides Vdrive, a system that offers navigation and stability for the diagnostic and therapeutic devices designed to improve interventional procedures; and V-Loop, V-Sono, and V-CAS disposable components. It markets its products through direct sales force, distributors, and sales agents. The company has a strategic collaboration with MAGiC catheter for cardiac ablation procedures. Stereotaxis, Inc. was incorporated in 1990 and is based in Saint Louis, Missouri.View Stereotaxis ProfileRead more More Earnings Resources from MarketBeat Earnings Tools Today's Earnings Tomorrow's Earnings Next Week's Earnings Upcoming Earnings Calls Earnings Newsletter Earnings Call Transcripts Earnings Beats & Misses Corporate Guidance Earnings Screener Earnings By Country U.S. Earnings Reports Canadian Earnings Reports U.K. Earnings Reports Latest Articles Is Reddit Stock a Buy, Sell, or Hold After Earnings Release?Warning or Opportunity After Super Micro Computer's EarningsAmazon Earnings: 2 Reasons to Love It, 1 Reason to Be CautiousRocket Lab Braces for Q1 Earnings Amid Soaring ExpectationsMeta Takes A Bow With Q1 Earnings - Watch For Tariff Impact in Q2Palantir Earnings: 1 Bullish Signal and 1 Area of ConcernVisa Q2 Earnings Top Forecasts, Adds $30B Buyback Plan Upcoming Earnings American Electric Power (5/6/2025)Advanced Micro Devices (5/6/2025)Marriott International (5/6/2025)Constellation Energy (5/6/2025)Arista Networks (5/6/2025)Brookfield Asset Management (5/6/2025)Duke Energy (5/6/2025)Energy Transfer (5/6/2025)Mplx (5/6/2025)Ferrari (5/6/2025) Get 30 Days of MarketBeat All Access for Free Sign up for MarketBeat All Access to gain access to MarketBeat's full suite of research tools. 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There are 7 speakers on the call. Operator00:00:00Good afternoon. Thanks for joining us for Stereotaxis 4th quarter and full year 2023 earnings conference call. Certain statements during the conference call and question and answer period to follow may relate to future events. Expectations and as such constitute forward looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements involve known and unknown risks, uncertainties and other factors, which may cause the actual results, performance or achievements of the company in the future to be materially different from the statements that the company's executives may make today. Operator00:00:43These risks are described in detail in our public filings with the Securities and Exchange Commission, including our latest periodic report on Form 10 ks or 10 Q. We assume no duty to update these statements. At this time, all participants have been placed on a listen only mode. The floor will be opened for your questions and comments following the presentation. As a reminder, today's call is being recorded. Operator00:01:15It is now my pleasure to turn the floor over to your host, David Fischel, Chairman and CEO of Stereotaxis. Speaker 100:01:24Thank you, operator, and good afternoon, everyone. It's a very exciting, productive, busy, challenging and promising period for Stereotaxis. We are glad to be entering this year having made significant progress towards realizing our strategic transformation. Given where we stand, we have high confidence in the key puzzle pieces of this strategy coming together in the coming months, putting Stereotaxis on a solid strategic foundation and providing line of sight to when commercial breakouts are possible. We are driving this progress against the backdrop of various challenges, which highlight the merit of our strategy. Speaker 100:02:07It is always helpful to view one's position in a broader context. This being our annual call, I want to use the occasion to step back and provide that perspective. I'll then share specific updates on our innovation and commercial efforts. Kim will then provide details on our financial results and we will open the line to questions. Stereotaxis' overarching mission is to improve minimally invasive endovascular surgery with the precision, safety and unique capabilities of robotics. Speaker 100:02:41We are the pioneer and global leader in endovascular robotics and have demonstrated the clinical relevance and value of our technology in robust real world use at over 100 hospitals that have treated 150,000 patients. Despite having pioneered a highly differentiated and advanced technology that works reliably in the real world and provides meaningful clinical value, Stereotaxis has a long history of commercial struggles. After joining Stereotaxis, I recognized that these struggles could be traced to structural weaknesses with our product ecosystem. These weaknesses put Stereotaxis in a challenging position with commercial disadvantages and strategic dependencies and made adoption of robotics very difficult even for our strongest advocates. We identified 3 key structural issues. Speaker 100:03:39First, in our core existing market, electrophysiology cardiac ablation procedures for the treatment of arrhythmias, we built our business dependent on Johnson and Johnson. We were only integrated with their diagnostic mapping system and they manufacture the ablation catheter used in every one of our procedures. That dependency limited the ability for patients and physicians to benefit from continuous innovation, created commercial challenges and provided Johnson and Johnson rather than Stereotaxis with the majority of economic value from every robotic procedure. 2nd, installing our robotic system in a cath lab is a significant construction process, requiring architectural planning, room shielding and reinforcement, special electrical work and hiring contractors, which all add complexity, time, effort and expense. This process leads to very long sales cycles and a high bar for adoption. Speaker 100:04:39The vast majority of interested potential customers ultimately never succeed in getting a system. 3rd, while Stereotaxis' robotic technology is designed as a platform technology enabling the treatment of a broad spectrum of complex endovascular procedures, the company did not offer the interventional tools to allow for this expansion of indications. Being limited to one specific procedure as large and attractive as the cardiac ablation market is doesn't provide for healthy diversification and full appreciation of our opportunity. Being clear eyed and intellectually honest was the first step in improvement. We worked hard over the subsequent years to formulate a comprehensive and elegant strategy to address these weaknesses. Speaker 100:05:30The strategy was creative and required significant innovation, but was realistic for us to accomplish while controlling technological and financial risk. It was attractive in providing strategic independence and opportunity for substantial commercial breakout. Most importantly, it fundamentally improves and broadens our product offering for the patients, physicians and hospitals that rely on us. Stereotaxis has advanced this comprehensive innovation strategy over several years through the development process. 2024 is the year in which we expect all the key puzzle pieces to come together, setting us up with multiple shots on goal for breakout growth in 2025. Speaker 100:06:18A few updates on the key innovation efforts follow. In our existing cardiac ablation market, our key effort has been to address our strategic dependency, develop a proprietary ablation catheter and create an open ecosystem around our robot. We were delighted today to announce initial clinical results and regulatory submissions for the MAGIC catheter, our proprietary advanced robotically navigated ablation catheter. Following our earnings call last November, we received approvals to initiate a human clinical trial of MAGIC in both Lithuania and Denmark. Julius University in Lithuania enrolled its first patient at the start of this year and completed enrollment of the 20th patient in January. Speaker 100:07:08The results from these initial procedures were stellar and were summarized by the physicians in a manuscript recently submitted for publication in a prominent electrophysiology journal. Across these 20 patients ranging in age from young adults to the elderly and suffering a range of arrhythmias, there was 100% acute success in treating the arrhythmias and no adverse events or device or procedure related safety events. Additional patients beyond these 20 have been treated in both Lithuania and Denmark with consistent positive results. Beyond the stellar clinical outcomes, qualitative commentary from all the physicians who participated in the trial was very positive, reinforcing our confidence in the impact MAGIC will have on patients and physicians. We resubmitted the MAGIC catheter to the European notified body and believe the data fully addresses the request made last summer where we were told clinical data would be necessary to be granted CE Mark under the more rigorous MDR requirements. Speaker 100:08:12We also submitted the MAGIC catheter for U. S. Regulatory approval as a PMA supplement to the FDA. The clinical data adds to a substantial body of bench, preclinical and published clinical literature supporting the value of robotic cardiac ablation generally and the safety and effectiveness of MAGIC specifically. While there is always uncertainty with any regulatory submission, we believe we made strong submissions and have received feedback to that effect from experts in our field. Speaker 100:08:44We look forward to working collaboratively with the regulatory bodies in the coming months to ensure the MAGIC catheter becomes available for the patients and physicians who depend on it. The launch of MAGIC will benefit from our strong collaboration with Abbott and last year's successful launch of mapping integration with Abbott's N Sight X mapping system. We are seeing continued expansion in the adoption of our integrated technologies in both the U. S. And Europe. Speaker 100:09:15This is a significant strategic collaboration in its early phases and we are delighted with how The second major initiative in our innovation strategy was to address the challenges and complexities of adopting robotics. We developed a smaller self shielding robot that significantly enhances its accessibility by removing the requirement for cath lab construction. We discussed on the last call our balanced approach to the timing of a regulatory submission such that approval of the robot aligns approximately with market availability of Magic. The robot has gone through design freeze and now begun formal testing. We are confident in regulatory submissions in both the United States and Europe in the Q2 and expect regulatory clearance in Europe mid year. Speaker 100:10:11Our experience selling Genesis gives us daily visibility into the timeline shifts and hospital construction delays that slow adoption, even at sites that are most motivated to build a robotic program. This experience reinforces our confidence that the availability of a smaller and more accessible robot, something that can be installed without construction, will serve as a significant structural improvement to the pace and scale of adoption. Following approval, we plan to use the current year to demonstrate the reality of the robot in real world use, enhance compatibility of the robot with various X rays and prepare our supply chain manufacturing, installation and commercial processes for a full launch in 2025. Our 3rd strategic innovation effort is development of a family of interventional guide wires and guide catheters that expand the benefits of our robots into new endovascular indications with 5 specific multibillion dollar opportunities being targeted: neurointerventions, coronary angioplasty, peripheral interventions, tumor embolization and AAA grafts. The first Guidewire is fully designed with our contract manufacturer, we've been grinding through the challenges of establishing high quality and robust manufacturing processes. Speaker 100:11:38We expect to complete the manufacturing and testing of the significant number of guide wires necessary for a regulatory submission in the middle of this year and still expect commercial availability of the guide wire late in the year. Once we have made regulatory submissions, we will host an innovation day to allow several key physicians from multiple specialties to share their perspective and experience with where our robotic technology can add critical value in the broader field of endovascular surgery. These three innovations, the MAGIC catheter, newer mobile robot and endovascular devices are our strategic response to the 3 structural limitations described earlier. We have line of sight to them attaining key regulatory approvals and commencing commercialization in 20 24 with growing commercial impact in 2025. Beyond these big three innovations, we were fortunate to nurture 2 additional opportunistic growth drivers that are synergistic and additive to our core effort. Speaker 100:12:45In China, we entered into a strategic collaboration with MicroPort to establish a China specific EP product ecosystem. MicroPort recently submitted to China's NMPA regulatory body, the robotically navigated ablation catheter we developed together. We have completed mapping integration with their Columbus mapping system and Genasys is expected to receive Chinese regulatory approval mid year. As this core product ecosystem is available, we expect to benefit from MicroPorts' substantial commercial footprint already servicing hundreds of hospitals. Our second synergistic and opportunistic venture is a digital surgery platform that enables broad operating room connectivity, both alongside our robotic platform and independently in non robotic been released internally for our team in preparation for an external release. Speaker 100:13:46We are still finalizing remaining hardware, firmware and software efforts with the Synchrony integrated display capability, but expect to begin formal regulatory testing in the Q2 followed by submissions in summer. We will continue a soft launch of SYNC till then, but plan for a full launch of Synchrony and SYNC as a combined solution enabling streamlined workflow, connectivity and collaboration broadly in any operating room. The Synchrony hardware will provide an incremental upfront capital sales opportunity, while Sync will be available with a freemium SaaS business model with premium subscriptions for hospitals, medical device sales forces and physician users. I recognize our progress has taken longer than expected and faced unforeseen challenges With key regulatory submissions and technology developments done, we see the puzzle pieces falling into place this year. While there is risk and uncertainty with any regulatory process, our strategy is de risked with multiple shots on goal. Speaker 100:14:53In each of our 3 key geographies, the United States, Europe and China, we have the opportunity for a full ecosystem coming together and driving breakout growth. The opportunity in any individual geography can dwarf our current entire business. We are driving this innovation transformation while working hard to ensure our commercial momentum and financial strength are preserved. We continue to see signs of commercial progress with positive feedback and utilization of Genesis as well as capital interest in Genesis from both existing users and completely new customers. In the Q4, we were excited to receive a Genesis order from a greenfield hospital in Germany. Speaker 100:15:41Germany as a country was one of the most enthusiastic earliest adopters of the first Niobe system and then also unfortunately the region with the strongest backlash for robotics given that the first Niobe systems were launched prematurely. To see our installed base grow with new physician users in Germany is particularly encouraging given that historical context. The order represented our 12th greenfield robotic order globally since the launch of Genesis and our 24th order overall. We begin 2024 with $14,700,000 in backlog from orders that were received, but not yet shipped or installed. While we continue to see a healthy pipeline of greenfield and replacement cycle customers for Genesis, overall progress is slow. Speaker 100:16:34Beyond the well understood challenges of closing a substantial capital sale for a system that requires hospital construction, several electrophysiologists have expressed their concern with the recurring catheter shortages of Johnson and Johnson and the awareness of the dependency on J and J catheters in absence of our own magic catheter as a replacement. While this has not deterred some hospitals from moving forward, it serves as an additional risk item that extends due diligence and delays purchase decisions. We believe our regulatory submissions of MAGIC will partially help and then obviously receipt of approvals will address this concern. Despite this pressure, we expect the continued pace of robotic system orders and sales with expected growth for both in 2024 compared to 2023. Our recurring revenue was also impacted by the catheter shortage from J and J, which impacted procedure volumes as well as the loss of royalty payments from J and J, which created a $2,000,000 headwind to both our top and bottom line results. Speaker 100:17:39We continue to see inconsistent availability of the J and J catheter flare up in various geographies and accounts, but expect overall recurring revenue in 2024 to be consistent with 2023. Our burn rate in 2023 was lower than 2022 despite these revenue challenges. So the absolute burn rate was still higher than what we expected. Our balance sheet remains strong with approximately $20,000,000 cash and no debt. We are cognizant of the importance of financial prudence and are confident our existing balance sheet allows us to advance our transformative product ecosystem to market and fund its commercialization. Speaker 100:18:24We have already invested in significant inventory and have direct commercial teams globally that are well suited to launch the new products as they become available. We expect a lower burn rate in 2024 compared to 2023, driven by increased Genesis robotic revenue and reduced cash outflows as some of the most significant R and D spending is behind us and we taper inventory purchasing. Kim will now provide additional commentary on our financial results and then I will make a few financial comments as well before opening the call to Q and A. Kim? Speaker 200:19:00Thank you, David, and good afternoon, everyone. Revenue for the Q4 of 2023 totaled $4,600,000 compared to $7,300,000 in the prior year Q4. System revenue was $100,000 and recurring revenue was $4,500,000 compared to $2,200,000 $5,100,000 dollars in the prior year Q4. System revenue was abnormally weak due to delays in hospital construction schedules and no shipments being made as a result. Recurring revenue was in line with recent quarters, but below the prior year level due to Stereotaxis no longer receiving royalty payments from Johnson and Johnson. Speaker 200:19:44Revenue for the full year 2023 totaled $26,800,000 compared to $28,100,000 in 2022. Full year system revenue was $8,700,000 compared to $6,800,000 in the prior year, reflecting increased system deliveries and installation. We started 2024 with system backlog of 14,700,000 revenue was $18,000,000 compared to $21,300,000 reflecting the continued absence of the J and J royalties and periodic catheter shortages by Johnson and Johnson. Operator00:20:23Gross margin Speaker 200:20:24for the Q4 and full year 2023 were approximately 60% 56% of revenue. For the full year 2023, we reported gross margins of 79% on recurring revenue and 8% for system revenue. System gross margins continue to reflect relatively low production volume combined with significant allocations of fixed overhead and related expenses. Operating expenses in the 4th quarter were 8,000,000 dollars Excluding $2,600,000 in non cash stock compensation expense, adjusted operating expenses in the current quarter were $5,400,000 compared to prior year adjusted operating expenses of 6,200,000 dollars Adjusted operating expenses for the full year 2023 were $26,200,000 compared to $26,800,000 in the prior year. Operating loss and net loss for the Q4 of 2023 were $5,300,000 $5,000,000 compared to $4,500,000 $4,200,000 in the previous year. Speaker 200:21:40Adjusted operating loss and adjusted net loss for the quarter, excluding non cash stock compensation expense, were $2,700,000 $2,400,000 compared to $1,900,000 $1,600,000 dollars in the previous year. For the full year 2023, adjusted operating loss of $11,300,000 dollars and adjusted net loss of $10,200,000 compared to an adjusted operating loss of $8,300,000 and an adjusted net loss of $7,800,000 in the prior year. Negative free cash flow for the full year 2023 was $9,100,000 compared to 10,800,000 dollars for the full year 2022. At December 31, we had cash and cash equivalents of $20,600,000 and no debt. I will now hand the call back to David. Speaker 100:22:36Thank you, Kim. We are cognizant that accurately guiding revenue has been challenging and there has been significant volatility in quarterly results as any individual robot sales has a significant impact on the quarter. Humbled by that experience, we are providing specific revenue guidance only for this current Q1 of 2024, in which we expect revenue of approximately $7,000,000 Looking at the full year recurring revenue to remain stable until Magic can contribute to disposable revenue growth. We expect continued growth in system revenue through conversion of our $14,700,000 backlog and new system orders, with system revenue growth driving overall double digit revenue for the year. We expect our bolus of innovation to play a decisive role in driving breakout revenue growth in 2025 and beyond. Speaker 100:23:38We will now take your questions. Operator, can you please open the line to Q and A? Operator00:23:44The floor is now open for your questions. Our first question comes from the line of Frank Taconan with Lake Street Capital Markets. Please go ahead. Speaker 300:24:14Great. Thanks for taking the questions. Maybe to start with the magic catheter submissions. On the EU submission, how should we handicap that being a resubmitted file? I assume that there's a little bit more certainty that they'll come back with a clearance on that now that they've had a chance to already review it once and they made their request. Speaker 300:24:33But maybe is there any way to kind of risk adjust that given it's already been looked at once and then 2 on the FDA side. 1 was that submitted and is that a standard 180 day review or how should we think about the process between now and the clearance expectation you put out there? Speaker 100:24:49Hi, Frank. Thanks for the questions. So generally, I want to state that we're not going to give a lot of commentary on regulatory submissions or the review during the review period. Other than that, we think we made strong submissions. And obviously, we're going to work collaboratively with the reviewers over the coming months I look forward to working collaboratively with them. Speaker 100:25:13Your commentary on the EU submission, you're correct. It is a resubmission of the vast, vast majority of the information with just the addition of the clinical data. We are fortunate that the reviewers are the same reviewers that looked at the submission a year ago, and so that should support the review process in a more efficient fashion. There is no statutory time limit of the review. So we are obviously beholden to the notified body and when they're able to review things. Speaker 100:25:54But given the history there and given the multiple discussions that took place last year, we are hopeful and believe it's reasonable to assume that this will be a much more efficient process. And with the U. S. FDA, this is 180 day PMA supplement, and we expect to work collaboratively with FDA during the review process. And it wouldn't be surprising if during that review process, we do kind of have additional questions and discussions with FDA. Speaker 100:26:31So we're not I wouldn't kind of think that necessarily the 180 days is has to be the way it's going to play out. But overall, it is 180 day PMA supplement how quickly Speaker 300:26:45the uptake could occur within the installed base? Maybe thinking about how quickly the uptake could occur within the installed base? Maybe starting with how many procedures you're doing today would be helpful context and then how quickly you can roll that, the MAGIX catheter into your established sites and swap out the old catheter for the new one? Speaker 100:27:08Sure. So we've talked before about doing under 10,000 procedures a year with approximately 40%, 45% of that volume in Europe, 40%, 45% of that volume in the U. S. And about 10%, twenty percent of that volume in Asia. And so that's kind of the overall installed base. Speaker 100:27:30So we have several 1,000 procedures a year each in both Europe and the U. S. U. S. Where in certain geographies, certain countries, certain regions, you do pursue then local tenders after you have CE Mark, while in others, really the only structural barrier is a contract with the hospital and setting a price with the hospital. Speaker 100:28:01And generally, I would expect, given also the fact that we are gaining a real world clinical experience with the catheter currently through the clinical trial, I would expect a relatively quicker ramp in catheter adoption as it becomes available. The things that we have to do in tandem with gaining regulatory approval And then also the work that we're doing with Abbott to convert existing users, which also also be beneficial in accelerating adoption. And so those are the things we think about as we think about adoption, but I overall expect to see a relatively rapid transition over, let's say, a handful of quarters. Speaker 300:29:04Okay. That's helpful. I'll stop there. Thanks for taking the questions. Speaker 100:29:07Thank you. Operator00:29:09Our next question comes from the line of Jason Witte with Roth MKM. Please go ahead. Speaker 400:29:17Hi, thanks for taking the questions and congrats on the submission here. In terms of you just kind of highlighted a little bit, but in terms of this year's outlook, should we expect anything from Magic this year or is it really a 2025 event? Speaker 100:29:34We didn't discuss and thanks for joining us, Jason, and glad to have you on the calls again. We didn't incorporate any revenue from Magic in the commentary we provided in terms of how we generally think about this year's revenue. And that said, it would be surprising if we do not generate some revenue from Magic in the back half of this year. It will really be dependent on the timing of regulatory approval in terms of how much to expect. And so I think until we don't have that approval in hand, it's hard for us to estimate how much to contribute. Speaker 100:30:16But I would definitely expect that we get at least one approval prior to the end of this year with the chance for Magic to start to contribute to recurring revenue. Speaker 400:30:27Okay. That's helpful. Thanks. And also I appreciate the backlog information of $4,700,000 I mean roughly what is the expectation in terms of how long those take to get placed in a hospital? Speaker 100:30:41Sure. So just it is $14,700,000 Speaker 300:30:45Okay. That's yes. Speaker 400:30:47If I say that wrong, apologies. Speaker 100:30:49No, fine. And so overall, we would estimate, and I'm looking at Kim right now, if she wants to correct me, that typically you would estimate that approximately 80% of that will be recognized as revenue and getting a thumbs up. So that seems correct. About 80% of that should be recognized within a given year. We have seen scenarios where hospitals that were planning to take delivery at a specific date, push back that date during due to their own challenges. Speaker 100:31:19And so there is there's not guarantees of that playing out as we've seen even up until the Q4, obviously, in the results of our Q4. But generally, that 80% within 1 year for backlog is a general rule that holds. Speaker 400:31:39Okay. That's helpful. Then last question. Just in terms of supply issues with the current catheter, are there any updates from your supplier? Or is there any change in outlook? Speaker 400:31:50Or how should we be thinking about this for 2024? Speaker 100:31:54Yes. So just to be clear, the catheter shortages are not from a supplier of ours nor from a company that we have any control over. This is all related to the dependency, which I described before, where Johnson and Johnson independently manufactures, sells and supplies the magnetic ablation catheters that are used alongside our robot. And so we do not have control over them or even influence over them in the same way that we would have influence with a supplier that we have hired and worked with. We have seen these crop top over a year ago now, about 1.5 years ago. Speaker 100:32:37We have seen continued shortages that flare up in various specific geographies, various accounts. And there is a randomness to it, though it does definitely pressure the physicians and hospitals that rely on our technology and create disturbances to their normal practices. And so I think given where we stand right now, it seems like the intensity and distribution of those flare ups doesn't seem worse than it was a year ago. And so it seems like overall, the numbers this year should look similar to last year, but there is an aspect of dependency there. And that again speaks to how valuable and important having magic on the market will be. Speaker 400:33:30Great. Thanks. I'll jump back in queue. Speaker 100:33:33Thank you very much, Jason. Operator00:33:36Our next question comes from the line of Alex Nowak with Craig Hallum. Please go ahead. Speaker 500:33:43Okay, great. Good afternoon, everyone. Continuing the manufacturing question there. Just with regards to MAGIC, if you do get the approvals, let's just say second half of this year for both Europe and U. S, how quickly can you ramp up manufacturing? Speaker 100:33:57Hi, Alex. Thanks and good afternoon. So overall, that is something that we've been working with Osypka, our contract manufacturing partner in Germany to improve. They have significant experience manufacturing thousands of units of various interventional devices. And so they have the organizational capabilities to do that. Speaker 100:34:25With every product, there is its own scaling effort. During the formal regulatory testing of Magic, we did produce, I believe it was near 1,000 units of the catheter. So they demonstrate their capability to manufacturing to those to that type of level. We are working with them, have been working with them, we'll continue working with them so that they can scale to the point where we're able to service the entire European and U. S. Speaker 100:34:55Installed base. I think that probably reaching that level still over the course of this year is probably aggressive, but that's what we're shooting for and there are all sorts of incentives in place to increase that manufacturing. Speaker 500:35:15Okay. That is great to hear. Maybe expand on the qualitative commentary with the physicians who are using MAGIC in the European study. Just what do they like about it versus the J and J device specifically? Speaker 100:35:28Sure. So I had the good fortune of being able to actually watch 8 procedures when I visited Vilnius University in January. And I think that kind of obviously, you recognize that the financial, the strategic, the independence benefits of having the catheter, the fact that the catheter serves as the enabling technology for our mobile robot. So all of those are kind of the more strategic aspects from our side. From a clinician's perspective, how does the catheter benefit the patient and the physician? Speaker 100:36:04I'd say that some of the main benefits that were described by the physicians, one was an observation that the stability of the catheter was particularly nice. And we are magnetic catheters are known that one of their key benefits is stability. Oftentimes, that stability is dependent on your approach towards the tissue. And they felt that irrespective of how they approach the tissue with the catheter, they had very, very good stability beyond what typically they considered very good stability with the existing magnetic catheters. So that was one thing that was particularly called out. Speaker 100:36:45The ease of navigation and how that was more intuitive than what they were used to was a second observation that was called out. And then the fact that reduced fluid is required to cool the catheter that should benefit patients that have renal issues or longer procedures that just generally creates reduced fluid load for patients. And so some of those were some of the things that I remember from a visit and from the discussions with physicians. I think kind of those are some of the key, key benefits both for patients and physicians as they switch to MAGIC. Speaker 500:37:25Okay, great. And then just last question, are you teeing up any U. S. Studies just in case the supplement, the FDA comes back and requests additional U. S. Speaker 500:37:35Data? Just how quickly could you turn something like that around? Speaker 100:37:40I believe in the coming months, we will have a much clearer feeling. Coming few months, we'll have a much clearer feeling for the regulatory path in the U. S. Given what we've done in Europe, that has been very helpful in educating us and giving us certain infrastructure to run clinical trials more broadly. And if you step back and think about Stereotaxis as a company, we have a very, very unique and kind of a special capability in terms of building robots. Speaker 100:38:14That's something that almost no other company has. Very few companies have demonstrated the capability to build robots that can actually be deployed in real world clinical setting and can work robustly and reliably there. We have that capability in house. We did not have a historical expertise or experience in developing interventional devices. And that doesn't just mean the engineering aspect, it means the quality, clinical, regulatory aspects related to interventional, intra body devices. Speaker 100:38:51I think that kind of as we've gone through this process, both from a regulatory perspective and now setting up the clinical trial in Europe and all the testing processes that we went through, that all gives us more of an institutional capability in order to replicate those again in the future. And so I think there was definitely a benefit from what we've now demonstrated we're able to pull off in Europe. And depending on how the next few months go, we'll have a feeling on whether it's necessary to start that in the U. S. Speaker 500:39:22Okay, great. I appreciate the update. Thank you. Speaker 100:39:25Thank you very much, Alex. Operator00:39:28Our next question comes from the line of Adam Maeder with Piper Sandler. Please go ahead. Speaker 600:39:35Hi, David and Kim. Thank you for taking the questions here. Wanted to ask a question on the sales force. With the magic launch and the mobile launch coming down the pike here, will you look to build out the sales force to support those launches? Is that a 2025 event or is the plan to kind of push forward with initial infrastructure sorry, the existing infrastructure? Speaker 600:39:59And then I had a follow-up. Thanks. Speaker 100:40:02Hi, Adam. Good afternoon. Thanks for the question. So we have done a small incremental hiring in Europe already late last year, early this year in anticipation of a Magic launch and ensuring that we have the ability to launch Magic across our installed base with the added level of coverage and service that, that would entail. And as discussed in the past, as we launch the catheter initially, we would plan to use our existing sales teams, both in the U. Speaker 100:40:40S. And Europe, to cover those accounts, to launch Magic. They are in all of these accounts. They have the relationships. We have a good team that has good electrophysiology knowledge. Speaker 100:40:53And so they are more than capable of launching the magic catheter in a successful fashion. We would though start to reinvest any proceeds from the catheter back into the sales team so that we grow the team and can gradually evolve to something more like the larger players in the space who oftentimes have 1 or even more than 1 individual per account, per hospital customer. And so I would see us kind of growing that sales team, but we would do it as we're growing the revenue of the magic catheter. Similarly, on the capital side, I would say that we are we know that with any new robotic system, the scaling of supply chain manufacturing and deployment of the robot is a process that takes many months. And even with the new robot that doesn't have the construction requirements, there are still those styles of infrastructure kind of process improvements that play out over a period of months. Speaker 100:41:58And so I'd say that we will probably as we gain approval, we will probably slightly increase the capital sales capability in the relevant geography. And then we'll start to show most of the benefit though from having the robot is that our existing capital sales teams should be able to be much more effective because we've reduced the complexity and time lines related to their sales work. And so as we start to see that playing out, as we start to see the robot being out there in the world, working successfully and well, as we're able to scale our supply chain and manufacturing, And then again, we'll incrementally be building the sales team. And so I think that kind of you'll see most of that type of real mind share and effort in building the commercial team happening in 2025 with some of the preparatory work being done already this year. Speaker 600:42:52That's great color. Appreciate that, David. Thank you. And for the follow-up, I wanted to switch gears and ask about mobile. If I heard correctly, regulatory submissions, both in the U. Speaker 600:43:05S. And Europe for Q2 events. Can you just maybe share what's left to still be done ahead of submission to the regulatory agencies? And just talk about what's informing the confidence there that you'll be able to make healthy submissions and ultimately garner regulatory clearance? Thank you. Speaker 100:43:27Sure. So we are we have the formal the full body of formal regulatory testing that you have to do before you can do a submission. There is still various testing that needs to be done there, most of it done internally with our team. Some of it that is done through external testing services that you have to do through an external testing service. And so that is all expected to play out over the next, let's say, month to couple of months. Speaker 100:44:03And then you have to obviously put together all of the documentation for the submission. And that happens concurrent with testing, but there's always some work after you finish the testing process. Overall, our confidence comes from the fact that we have this is really our expertise, robots. We went through a process very, very similar to this just about 4 years ago, 4, 5 years ago when we submitted the Genesis robot. And so we have the organizational infrastructure, the muscle memory, the documentation that we can leverage for these types of processes. Speaker 100:44:43And we have a skilled team that has run this playbook before, including very recently. So that gives us the confidence. We've had preparatory discussions with regulators. We have clarity on what the regulatory path is. And so that gives us kind of that confidence. Operator00:45:10This concludes today's question and answer session. I would now like to turn the call over to David Fischel for closing remarks. Speaker 100:45:19Okay. Thank you very much for all your thoughtful questions and for your continued support. We look forward to working hard on your behalf this year, bringing about the transformations we promised and speaking again in a couple of months. Thank you. Operator00:45:31This concludes today's call. You may now disconnect.Read morePowered by