{
  "docId": "019dd923-622c-750b-8b98-08d95731b035",
  "docSlug": "4dea9707af58",
  "documentTitle": "AtriCure, Inc. (ATRC)",
  "authorId": "53_Kerrisdale_Capital",
  "authorName": "Kerrisdale Capital",
  "documentKindSlug": "research-note",
  "documentKindLabel": "Research note",
  "sourceTypeSlug": "short_seller",
  "sourceTypeLabel": "Short seller",
  "presentationDate": "2020-09-01 00:00:00",
  "orientation": "portrait",
  "aspectRatio": 0.77272725,
  "pageNumber": 4,
  "pageCount": 34,
  "prevPage": 3,
  "nextPage": 5,
  "slideType": "villain_critique",
  "function": "name_villain",
  "density": "dense",
  "nDataPoints": 2,
  "notes": "The slide uses a narrative structure to discredit the CONVERGE IDE trial results by highlighting procedural flaws and superior alternatives.",
  "elementsJson": [
    "paragraph"
  ],
  "metadataConfidence": 0.95,
  "imagePath": null,
  "slideHref": "/slides/019dd923-622c-750b-8b98-08d95731b035/4",
  "deckHref": "/decks/019dd923-622c-750b-8b98-08d95731b035",
  "deckJsonHref": "/decks/019dd923-622c-750b-8b98-08d95731b035.json",
  "deckAnchorHref": "/decks/019dd923-622c-750b-8b98-08d95731b035#slide-4",
  "components": [
    {
      "bbox": null,
      "kind": "callout",
      "text": "Considering that EPs are supremely confident in their ability to isolate both cardiac structures, we expect Convergent to be a massive commercial failure, ending up exactly like AtriCure’s previous attempts to popularize stand-alone surgical ablation.",
      "attrs": null,
      "subkind": null,
      "toolName": "Visual emphasis",
      "toolSlug": "visual-emphasis",
      "confidence": null,
      "componentId": "019dd953-0396-73da-b905-5d544a2ef568",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.15,
        "w": 0.78,
        "x": 0.11,
        "y": 0.09
      },
      "kind": "paragraph",
      "text": "of a small abdominal incision through which a tubular ablation device is inserted. The small incision means the device can only access a small section of cardiac tissue for ablation – the posterior left atrial wall – leaving the pulmonary veins, which are the most frequent trigger of AF, untouched. As a result, Convergent requires a second procedure – a standard endocardial catheter ablation, performed by an EP, to isolate the pulmonary veins, which are the most frequent trigger source of AF.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "370d5d7a-e15f-4e71-a4ba-b042c81ef64a",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.3,
        "w": 0.78,
        "x": 0.11,
        "y": 0.41
      },
      "kind": "paragraph",
      "text": "The problem for AtriCure and Convergent, is that the ability to conduct complete posterior-wall isolation (PWI) as part of a standard catheter ablation has advanced dramatically in recent years. That’s why the results of the recent CONVERGE IDE trial – hailed as some sort of conclusive victory for hybrid ablation procedures by AtriCure and its investors – are totally irrelevant, and even misleading. In the trial, two groups of patients with persistent AF were treated with ablation: the experimental arm underwent the Convergent procedures while the control arm underwent a catheter ablation that included only a PVI. Not shockingly, a larger percentage of the experimental group (68%) were free from AF 12 months post-procedure than the control group (50%). But the superiority of more extensive ablation – a combination of PVI and PWI compared to PVI-only – was never in doubt. That combination, though, can be accomplished more safely, and just as effectively, in a single catheter ablation procedure than in two ablation procedures, the first of which is a minimally invasive surgery.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "3da2e89a-5159-41f1-8ded-2c4fe86d0255",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.15,
        "w": 0.78,
        "x": 0.11,
        "y": 0.25
      },
      "kind": "paragraph",
      "text": "This “hybrid” approach to stand-alone ablation – combining a minimally invasive epicardial ablation with a standard endocardial catheter ablation – made some sense when the concept was first introduced about ten years ago. Pulmonary vein isolation (PVI) via catheter ablation was just being perfected, and it wasn’t effective in most patients suffering from persistent AF, in which other areas of the heart besides the pulmonary veins also triggered arrhythmias. The addition of a minimally invasive procedure to ablate some of those other sources – as Convergent does with the posterior wall – would improve the efficacy of ablation for these patients.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "3edd1bb7-7ed8-4cd0-803a-487e3d8ef4fc",
      "frameworkName": null,
      "frameworkSlug": null
    },
    {
      "bbox": {
        "h": 0.22,
        "w": 0.78,
        "x": 0.11,
        "y": 0.72
      },
      "kind": "paragraph",
      "text": "Study after study has shown that a catheter procedure that isolates both the PVI and PWI can durably control AF as well as, or better than, the Convergent procedures did in the CONVERGE experimental group. None of this is lost on electrophysiologists. Every single EP we spoke with – and even some of the surgeons – was quick to point out the CONVERGE design flaws, and asserted their ability to perform a dual PVI/PWI ablation solely with a catheter in an outpatient procedure, sparing the patient a hole in the abdomen, a night in the hospital, and a longer recovery time. This doesn’t bode well for the uptake of Convergent – surgeons can only perform the procedure if they get a referral from...the patient’s electrophysiologist. Considering that EPs are supremely confident in their ability to isolate both cardiac structures, we expect Convergent to be a massive commercial failure, ending up exactly like AtriCure’s previous attempts to popularize stand-alone surgical ablation.",
      "attrs": null,
      "subkind": "paragraph",
      "toolName": null,
      "toolSlug": null,
      "confidence": null,
      "componentId": "57e70f52-3dde-4824-8141-c11787dcb56a",
      "frameworkName": null,
      "frameworkSlug": null
    }
  ],
  "metrics": [],
  "tools": [],
  "frameworks": [],
  "arcBeats": [
    {
      "to": 5,
      "from": 1,
      "beatId": "49b35616-8bdd-4f05-b34e-76b4fa89dc74",
      "arcName": "Overcoming the Monster",
      "arcSlug": "overcoming-monster",
      "beatName": "The Monster",
      "beatSlug": "overcoming-monster-the-monster",
      "evidence": "The problem for AtriCure and Convergent is presented",
      "position": 0,
      "confidence": 0.8,
      "parentBeatName": "Hook",
      "parentBeatSlug": "hook"
    }
  ],
  "loops": [],
  "imagePathAlt": null,
  "thumbSrc": null,
  "thumbSrcAlt": null,
  "locked": true
}