AtriCure Q4 Earnings Call Highlights

Key Points

• AtriCure reported full‑year 2025 revenue of $534.5 million (about 15% growth), nearly $62 million in adjusted EBITDA and positive cash generation, and reaffirmed 2026 guidance of $600–$610 million in revenue (12–14% growth) with adjusted EBITDA of $80–$82 million.
• Revenue momentum was driven by newer product launches — notably pain management (cryoSPHERE MAX with ~500 U.S. accounts and >100,000 patients treated) and open appendage/ablation (AtriClip FLEX MINI in >300 accounts; Encompass in >830 accounts) — while minimally invasive AFib devices faced a headwind from PFA adoption (U.S. MIS revenue down ~31% in 2025).
• Clinical and pipeline progress includes completion of the LEAPS enrollment (~6,573 patients), initiation of the 960‑patient BOX X NoAF trial, first‑in‑human use of a dual‑energy EnCompass clamp, and a deliberate CryoXT rollout expected to contribute revenue in H2 2026.

AtriCure NASDAQ: ATRC reported fourth-quarter and full-year 2025 results that management said reflected accelerating growth in several core franchises, improving profitability, and progress on major clinical and product development initiatives. The company also reaffirmed its 2026 outlook for 12% to 14% revenue growth.

Full-year and fourth-quarter financial results

For full-year 2025, AtriCure posted worldwide revenue of $534.5 million, up 14.9% reported and 14.4% on a constant-currency basis. CEO Mike Carrel said total revenue was $534 million, reflecting 15% growth over 2024, and highlighted “substantial improvements” in profitability and cash generation, including nearly $62 million in adjusted EBITDA and $45 million in cash generated in 2025.

In the fourth quarter, worldwide revenue was $140.5 million, increasing 13.1% reported and 12.1% on a constant-currency basis compared with the prior-year period. CFO Angie Wirick said U.S. revenue rose 12.6% to $114.3 million, supported by newer product launches in pain management and open appendage management—specifically cryoSPHERE MAX and AtriClip FLEX MINI—as well as continued adoption of the Encompass clamp in open ablation. International revenue was $26.2 million, up 15.3% reported and 9.9% constant currency.

Fourth-quarter gross margin was 75%, up 45 basis points year over year, driven primarily by favorable product mix. AtriCure reported fourth-quarter net income of $1.8 million versus a $15.6 million net loss a year earlier, and adjusted EBITDA of $19.9 million versus $12.7 million in 2024. EPS was $0.04 and adjusted EPS was $0.06, compared with a loss per share of $0.33 and adjusted loss per share of $0.08 in the prior-year quarter.

For the full year, gross margin was 75%, up 29 basis points from 2024, which management attributed to favorable mix and production efficiencies. Adjusted EBITDA rose to $61.8 million from $31.1 million in 2024. AtriCure ended 2025 with $167.4 million in cash and investments.

Franchise performance and product momentum

Management said 2025 performance was driven by newer product launches and adoption across three of four franchises. In pain management, Carrel said fourth-quarter growth was 24%, with full-year worldwide revenue up 33%, marking an acceleration from 2024. He cited continued adoption of the cryoSPHERE MAX device, noting the company ended the year with roughly 500 U.S. accounts using cryoSPHERE MAX and surpassed 100,000 patients treated with cryoSPHERE probes since the franchise launched in 2019.

Appendage management also grew, with Carrel reporting 15% global growth in the fourth quarter and 19% worldwide growth for the year. He said open left atrial appendage growth outpaced minimally invasive (MIS) devices, and highlighted AtriClip FLEX MINI and AtriClip PRO MINI as key drivers due to the low profile of the “mini” devices. The company exited 2025 with more than 300 active accounts purchasing FLEX MINI, which contributed 18% of worldwide left atrial appendage management revenue in 2025, according to Carrel.

In open AFib ablation, Carrel said growth exceeded 17% in both the fourth quarter and full year, primarily driven by the Encompass clamp. He said Encompass was present in more than 830 accounts worldwide, reflecting a mid-teens increase over 2024. Wirick added that U.S. open ablation sales were $143.8 million, up 16.3% year over year, and that Encompass contributed more than 60% of U.S. open ablation revenue in 2025.

The company’s minimally invasive AFib treatment franchise remained under pressure from pulsed field ablation (PFA) adoption in the U.S. Carrel said hybrid AFib therapy “continued to feel the pressure” and described it as a significant headwind. Wirick reported U.S. MIS revenue of $31.5 million, down 31.2% in 2025 as customers prioritized PFA catheters. Management noted sequential U.S. improvement from the third to the fourth quarter and added accounts performing the conversion procedure, but said it remains prudent in its 2026 outlook and is assuming continued pressure, albeit at a lower rate of decline than in 2025.

Clinical trials and pipeline updates

AtriCure emphasized progress on two large clinical programs aimed at expanding treatment in cardiac surgery patients without pre-existing AFib. Carrel said the LEAPS trial completed enrollment of more than 6,500 patients in July 2025, ahead of expectations, with more than 500 surgeons across 137 sites participating. On the call, management specified LEAPS enrolled 6,573 patients. The company is continuing patient follow-up.

Carrel said AtriCure initiated the BOX X NoAF trial, a 960-patient randomized controlled trial evaluating ablation intended to reduce postoperative AFib in cardiac surgery patients without pre-existing AFib. Management said site initiation and enrollment were progressing and that it would provide updates through the year.

On product development, Carrel described work on a dual-energy EnCompass clamp intended to shorten RF ablation times and add PFA as a complementary energy source. He said AtriCure completed first-in-human treatments in December with “excellent results,” and expects to complete device development and generate data in preparation for initiating a clinical trial.

The company also discussed its expansion in surgical pain management, including amputation procedures. Carrel said AtriCure launched CryoXT in the third quarter of 2025 and is taking a deliberate rollout approach, with each Crown NeuroBlock representative focusing on one account at a time to ensure adoption is “sticky.” He said CryoXT is expected to contribute more meaningfully to revenue in the back half of 2026.

Competitive and reimbursement dynamics

During the Q&A, management addressed questions about competitive entry in the appendage management market. Carrel said AtriCure views competitor entry as validation and argued that increased attention can expand market conversations. He cited AtriCure’s installed base and clinical evidence, stating the company has over 750,000 implants and an “incredible safety rate” of 0.007%, and noted that LEAPS includes only AtriClip in the trial. Wirick said the company’s 2026 guidance incorporated “very mild” competitive pressures, particularly in the back half of the year, and emphasized efforts to broaden adoption of FLEX MINI.

Internationally, Wirick said fourth-quarter results were affected by a decline in U.K. sales tied to funding and reimbursement uncertainty with the National Health Service (NHS). Later in the call, she said the two biggest U.K. impacts were pain management, where the NHS pulled reimbursement and sought different coding, and standalone AFib treatment, described as elective procedures. She said the U.K. had been running at about a $4 million per quarter run rate and dropped to a little over $1 million in the fourth quarter.

2026 outlook and profitability expectations

AtriCure reaffirmed its 2026 guidance of $600 million to $610 million in revenue, representing 12% to 14% growth over 2025. Wirick said pain management is expected to lead growth again, followed by open appendage management and open ablation. The company expects MIS ablation and MIS appendage management revenue to decline in 2026, but at a moderated rate, and it anticipates U.S. and international growth rates to be more closely aligned, with continued uncertainty in the U.K. throughout 2026.

On margins, management expects modest gross margin expansion in 2026 from mix and cost savings initiatives, and continued operating leverage, with SG&A expected to grow below the top-line growth rate. Wirick said R&D expenses are projected to moderate, with low-teens organic growth and mid-teens growth when including PFA milestone payments.

The company reaffirmed adjusted EBITDA guidance of $80 million to $82 million and said it expects full-year net income in 2026. Wirick guided to EPS of approximately $0.00 to $0.04 and adjusted EPS of $0.09 to $0.15. Management also said it anticipates another year of positive cash generation, while expecting net cash burn in the first quarter due to typical seasonal outflows such as variable compensation payments and share vesting.

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.

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