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  "documentTitle": "Acutus Medical Inc. (AFIB)",
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  "authorName": "Kerrisdale Capital",
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  "presentationDate": "2021-07-01 00:00:00",
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  "notes": "This is a text-heavy research note page detailing the 'stumbles' of Acutus Medical and the subsequent resolution of these issues.",
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      "text": "One mistake Acutus made early on in its commercialization efforts was to take a shotgun approach and get its system hardware installed in as many high-volume electrophysiology centers as possible.",
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      "text": "All of the above obstacles - lack of rigorous physician training, overly broad sales focus, and misguided marketing - have been resolved by Acutus over the last few months. As the pandemic has ebbed, the logistical restrictions on training have fallen and, at the same time, Acutus's new Chief Commercial Officer - Duane Wilder - has both expanded the training regimen and bulked up the training and mapping staff to assist physicians in making the workflow and procedural changes that are entailed in the adoption of AcQMap. The new training",
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      "text": "One mistake Acutus made early on in its commercialization efforts was to take a shotgun approach and get its system hardware installed in as many high-volume electrophysiology centers as possible. The thinking was that AcQMap was so good, system installations would be inexorably followed by increasing utilization of AcQMap in ablation procedures. But that's not what happened. Instead, at many labs, utilization dropped to almost nothing after the first few procedures. Partly, this was due to inadequate initial physician training on the part of Acutus, which was itself very much driven by the logistical difficulty of setting up training centers, inviting EPs to Acutus's central training facilities, or providing on-premises close-contact training in the middle of a raging pandemic. Another issue was that Acutus reps didn't discriminate in their push to rack up system installs, and many centers that were philosophically oriented towards empirical ablation methods ended up with an AcQMap system that's a lot less useful for EPs who know exactly which tissue they're going to ablate even before they insert their catheters.",
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      "text": "Marketing in the first year of AcQMap's commercialization was also a factor in subpar utilization. Acutus's strategy was to focus on the \"holy grail\" aspects of AcQMap, namely the ability of the EP to use the technology to find the triggers of AF in complex cases and subsequently ablate them. While it's true that AcQMap has proven its ability to increase the effectiveness of an ablation procedure, there were two problems with the marketing approach. The first was, again, training: the pandemic made it difficult for Acutus to adequately train EPs to exploit AcQMap's advanced capabilities to improve procedural outcomes.",
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      "text": "recovered. Based on extensive conversations with EPs and hospital procurement managers, we believe Acutus's stumbles stem from a temporary but unlucky combination of pandemic-driven purchasing and training hurdles, excessively broad early sales targeting, and a strategically misguided initial marketing message from which Acutus has since successfully pivoted.",
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      "text": "More importantly, though, is that EPs have been subjected to numerous new technologies over the last decade with the promise of finally finding the physical sources of AF. The most spectacular of these failures was Topera, which originally promised that it could map the entire atrial chamber simultaneously over multiple heart beats in real time, which sounds a lot like what AcQMap does. A year and a half after Abbott acquired Topera for $250 million in late 2014, a controversial RCT was published that showed that Topera's mapping catheter could not demonstrate improved outcomes in persistent AF patients. Never mind that Topera's mapping catheter was an extremely low resolution contact mapping system that relied on extremely questionable algorithms to identify non-PV triggers. The Topera experience, and other less memorable failures, have taught EPs to be skeptical of any technology that claims to be able to identify the sources of AF.",
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