Medtronic gains 9 EP share points as Boston Scientific stalls

Medtronic's cardiac ablation business grew 88% worldwide and 139% in the United States last quarter, taking 9 US share points from Boston Scientific in a $16.73 billion electrophysiology market that both companies need to defend.

"This is a share fight in the fastest-growing part of cardiology, and right now one company has the product cycle and the other is waiting for one," Marie Thibault, Managing Director and Medical Technology Analyst at U.S. Bancorp | BTIG, said. She expects electrophysiology to grow in the low-to-mid teens over the coming year.

The divergence shows up in the numbers. Medtronic's first-quarter fiscal 2027 Cardiovascular revenue rose 18.9% organically, led by 29.1% growth in Electrophysiology Therapies. Its Cardiac Ablation Solutions unit passed $2 billion in trailing 12-month revenue ahead of plan. Boston Scientific, by contrast, told investors to expect electrophysiology growth to be flat in the second half of 2026, with third-quarter US electrophysiology sales projected to fall mid-single digits sequentially.

The market backdrop is not the problem. Precedence Research values global electrophysiology devices at $16.73 billion in 2026 and projects a 14.31% compound annual growth rate through 2035, driven by an aging population and the shift to pulsed field ablation (PFA), which uses short electrical pulses instead of heat or cold to isolate the tissue causing atrial fibrillation.

PFA Rewrote the Scoreboard in Two Years

Boston Scientific created that shift. Its FARAPULSE platform moved the US market to PFA faster than management expected, and PFA now accounts for roughly 80% of US atrial fibrillation revenue. The speed of that adoption is also the source of the problem: it pulled forward demand for a first-generation system while competitors built second-generation ones.

Medtronic's answer has been to win on procedure breadth rather than a single platform. Cardiac Ablation Solutions gained 9 US share points and now sits above $2 billion in trailing 12-month revenue, a scale that lets Medtronic price aggressively against Boston Scientific's installed base. Boston Scientific's response is a pipeline, not a product: FARAWAVE Ultra and an entry into intracardiac echocardiography (ICE) are slated for the second half of 2027, with FARAFLEX following in 2028. That is a two-year gap in a market compounding at 14.31%.

International sales are the offset. Boston Scientific still expects roughly 20% full-year growth outside the US, where FARAPULSE penetration is earlier and pricing holds better.

The pressure is not confined to ablation. Boston Scientific's WATCHMAN left atrial appendage closure franchise faces a mid-to-high single-digit sales decline in the second half of 2026, with full-year growth flat to low single digits. New clinical evidence on stroke risk in atrial fibrillation patients has disrupted patient identification and referral patterns, and rapid adoption of concomitant procedures has created operational friction between concomitant and standalone workflows. Thibault said the medical community is still working out which patients are best served by left atrial appendage closure versus oral anticoagulants, and that the company should expect the issue to persist "for a few quarters."

Medtronic's Non-EP Franchises Are Doing the Heavy Lifting

Medtronic is not relying on electrophysiology alone. Its Medical Surgical segment is pushing the Hugo robotic-assisted surgery system, which received FDA clearance for urologic procedures in December 2025; in June 2026 the company filed 510(k) submissions to extend Hugo into general and gynecologic procedures in the US. Management expects Hugo to exceed 50,000 procedures by fiscal 2027 year-end, with procedure growth more than twice the robotic surgery market rate. A strategic partnership with Cornerstone Robotics supports that build-out.

Neuroscience is growing more than 20% annually across Cranial & Spinal Technologies and Specialty Therapies, helped by the SPR Therapeutics acquisition and a distribution agreement with Merit Medical. Scientia Vascular adds procedural workflow coverage. In hypertension, Medtronic is scaling Symplicity Spyral renal denervation after the final Medicare National Coverage Determination improved reimbursement, with a transradial catheter launch planned for the second half of fiscal 2027.

Boston Scientific's diversification is thinner where it matters most right now. MedSurg provides a base, and the Nalu Medical acquisition expanded Neuromodulation with a full-quarter contribution in the second quarter. Urology remains weak as sacral neuromodulation recovery runs slower than expected and stone-management portfolio gaps persist; management expects to close those gaps over the next three quarters. The planned $14.5 billion Penumbra acquisition, expected to close in the second half of 2026, would broaden vascular exposure but does nothing for the electrophysiology gap.

Estimates have moved in the same direction as the share data. The consensus 2026 EPS estimate for Boston Scientific implies 7.5% growth to $3.29 and has fallen 1.8% over the past 60 days. Medtronic's fiscal 2027 consensus EPS estimate of $5.97 implies 8% growth and has risen 0.5% over the same period. Boston Scientific trades below both its 50-day and 200-day simple moving averages; Medtronic trades above both. Over the past three months, Boston Scientific has declined 2.1% while Medtronic has gained 18.6%.

The trade is not one-way. Medtronic still carries exposure to trade policy, inflation and geopolitical disruption that could pressure operating costs and margin recovery, and its 18.6% three-month run means much of the share-gain story is already in the price. Boston Scientific's case rests on whether FARAWAVE Ultra and ICE stabilize US electrophysiology in the second half of 2027 — a catalyst more than a year away, against a competitor compounding at 88% in the segment today. Investors holding Boston Scientific are being asked to underwrite a pipeline; investors holding Medtronic are being asked to pay for one that already shipped.

This article is for informational purposes only and does not constitute investment advice.