Daniel Stauder: Great. Thank you. And then this one follow-up, turn to appendage management. The growth in MIS ablation was great to see, but with that, are you seeing an uptick in your AtriClip minimally invasive procedures? And then could you remind us where that AtriClip mix has opened to MIS today and how has that changed over the past year or so, and where you think that could go in 2024? Thank you.
Angela Wirick: Yeah. That was a nice byproduct of the strength of our MIS business in the fourth quarter. We saw an uptick in our MIS appendage management, the AtriClip Pro products, realizing pretty equal growth to the open AtriClip products leading to about 22% growth to the fourth quarter in the U.S. And our attachment rates, we continue to see a steady increase in attachment a year or so ago. We were talking about around a 75% attachment to our CONVERGE procedure and now we’re, I’d say, kind of mid-80s at this point in time and continue to receive really good, strong feedback from accounts that are starting CONVERGE programs or have adopted CONVERGE programs, the interest in treating the appendage surgically during the CONVERGE procedure.
As we exited the year, when you look at our U.S. appendage management business, about 25% of the revenue was from our MIS AtriClip business and about 75% of the revenue was in our open Clip business and I think, given the strength of both of those franchises, our open and MIS ablation businesses would expect for that next to remain relatively similar with the potential for upside, I think, for the MIS product.
Daniel Stauder: Great. Thank you very much.
Operator: Thank you. Our next question comes from the line of Suraj Kalia with Oppenheimer & Company. Your line is now open.
Suraj Kalia: Hi, Angie, Mike. Can you hear me all right?
Angela Wirick: We can hear you.
Suraj Kalia: Perfect. Hey, Mike. So, a couple of esoteric questions. I was wondering if you could help us out. AtriClip, in general, is it on consignment or should we think about inventory also? And more specifically, as you’ll enter FY ’24, just given all the dynamics and your prepared remarks, how should we think about the pricing flow through that you’ll think about for FY ’24?
Michael Carrel: Yeah. On the consignment, we don’t really have any consignment product. That’s not typically it’s — we’re very much on kind of a use and then replace. So, we keep very, very little inventory whatsoever at sites, just enough for them to kind of plan out the procedures in the upcoming week or two. But we do not have a lot of inventory on shelf. That’s actually purposeful. We want to understand the demand. And we’ve got great inventory here to be able to supply that on a real time basis. We’ve got 99.8% kind of delivery to make sure that no patient is not being treated from that standpoint. Related to price, we feel like we’ve got a really good pricing strategy today. We’ve obviously got a product on the market.
Our initial one, our original AtriClip, kind of the kind of first three generations of the product are out there today. Those are priced at a lower level. The FlexV, which was our premium product today, is also in the market. Our highest priced product of the minimally invasive products above that. So I think we’re in a really good position relative to pricing today. And we don’t have any specific things to change anything on that front in the near future.
Suraj Kalia: Got it. Mike, in terms of AtriClip Mini, is this just a desire for product stratification? And what I’m looking at is in terms of complete isolation of the LAA, you’re presumably going a smaller form factor. So just kind of walk us through the rationale for introducing Mini. And Mike, also remind us in terms of persistent AF, what percent of the cases being done by AtriCure today are persistent AF versus longstanding persistent AF? Thank you for taking my questions.
Michael Carrel: Sure. On the FLEX Mini, we spend a lot of time, as we mentioned in our comments, we’ve had 500,000 implants to date. And we do a lot of work with our customers to figure out what improvements do they want to have to the product. And so the biggest thing was really, quite frankly, they wanted a smaller product, meaning that it’s just a smaller profile overall. That’s what the FLEX Mini does. It actually is about a third the profile of the other products. And that’s the biggest benefit that people are going to get relative to using that. Also, as many of you may know, we’ve got a V-shaped product, and we also have a hoop-like product, which is the original product that we had on the market. The hoop-like product is the one that does not have as good of a deployment as the V-Clip product.
And so many people wanted a hoop-like product that was smaller and had a very nice and easy and usable deployment tool with it as well. And so that was the primary feedback that we got from people. And that’s effectively what the Mini brings to market. In addition to that, and probably as important, is that the Mini is also going to be used in our — we have the ProV product for minimally invasive, and we will have a ProMini product as well that’ll come out in late 2025, likely. And that product is going to be able to go through at least a seven millimeter, possibly a five millimeter trocar to make it even less invasive as somebody actually has to do the procedure from a minimally invasive perspective. So the product, by being so — the profile being so small, it can go through those smaller trocars, and there’s a big benefit on that.
In terms of your second question, I guess, I believe you’re probably talking about the CONVERGE area in terms of the distinction between persistent and longstanding persistent. Our label is for longstanding persistent. That’s what we talk to. I’d say most of the patients fit within the longstanding persistent marketplace. Very few are persistent patients in terms of what we’re seeing. Most of the patients that we see are patients that have had failed catheter ablations, one, two, or three failed catheter ablations before they then go to a CONVERGENT or a Hybrid type procedure. And so, I believe that might be what you’re referring to, and hopefully I answered that question.
Suraj Kalia: Fair enough. Thank you.
Operator: Thank you. This concludes the question-and-answer session. I’d now like to hand the call back over to Mike Carrel, CEO, for closing remarks.
End of Q&A:
Michael Carrel: Great. Again, everybody thank you for joining us today, and we look forward to having a great 2024 together. Have a good one. Bye now.
Operator: This concludes today’s conference call. Thank you for your participation. You may now disconnect.
