Bob White: Great. Thanks Geoff and Cecilia, thanks for the question. As you have noted, the trial enrollment is underway for expand neuro. First patients have been enrolled and proceeding nicely on that. So, we are pleased with our progress on that IDE specifically. And then just more broadly, to Geoff’s point, last quarter, we saw accelerated installations of Hugo entered new markets across EMEA, APAC and LATAM. And again, if you think about where we are at around the world, with the geographic expansion and our CE mark allowing us to expand in the new markets. And then in CE markets, we have also added our general surgery indication on top of urology and gynecology. So, now we covered about 80% of robotic procedures in those markets.
And what we have been pleased, and you asked a little bit about feedback, we are getting really good feedback. The systems been used now to successfully perform a range of urology, gynecological, general surgery procedures from kind of simple to complex. And we are seeing that Hugo is the flexible and versatile tool we designed it to be. So, it’s early innings in terms of €“ again, this market has got tremendous growth opportunity. Only 5% of procedures are done globally that could be done robotically assisted. We remain very excited about the market, and we are pleased with where we are today.
Karen Parkhill: And Cecilia, on the Italy question, there is a law in Italy that requires companies that are €“ that sell medical devices to make payments to the Italian government if those device expenditures exceed maximum ceilings. The law was put in place in 2015 and applies to expenditures from that year onward. You have heard from some of our other competitors on this. The law is obviously applicable to the whole industry. And we filed an appeal along with many other companies in our industry on this. In the third quarter, for the first time, actual claims were issued to Medtronic and our peers for the years €˜15 to €˜18. And so, we did revised our existing accrual. We already had an accrual and we did add to it in the third quarter. That accrual is a reduction of revenue. For us, it wasn’t too significant, but we do have a reserve on our books.
Ryan Weispfenning: Thanks Cecilia. Let’s take the next question please, Brad.
Operator: The next question comes from Shagun Singh at RBC. Shagun, please go ahead.
Shagun Singh: Great. Thank you for taking the question. Karen, one for you. Could you just elaborate on the components of the impact €“ of the components of the EPS impact on growth next year? You called out inflation, FX, interest and taxes. Perhaps you can talk about how large the impact is this year and what the flow-through could be next year? And then I have a follow-up.
Karen Parkhill: Yes. Thanks Shagun. So obviously, we have said we have got tons of moving pieces on next fiscal year. So, we are not ready to give real guidance. And so, to quantify, the impact from EPS growth is difficult. But what I would say on currency, we talked about the fact that, that is a headwind. I mentioned that in the commentary. And just at recent rates, currency is about a 5% headwind to next fiscal year, so we did quantify that. We also said that inflation impacts are about a mid-single digit impact for us next fiscal year. So, those are two that we have quantified. In terms of interest and tax, those are more minor headwinds than inflation and currency, but still headwinds that we need to face. And then obviously, we have got investment that we intend to make to drive the long-term growth of this company.
And where we see important investments, we are going to make them. And we have said that we think that we are going to drive R&D growth, at least in line with revenue and when we have important investments to make in some areas that may grow even more than revenue. So, hopefully that helps.
Shagun Singh: That’s helpful. Thank you. And I was just wondering if you could talk a little bit about the PULSED AF data readout at ACC. How meaningful do you think it could be? And just maybe broadly talk about the PFA opportunity and how your platform is differentiated? Thank you so much.
Geoff Martha: Sure. Thanks for the question. We are definitely excited about the data that’s coming out at ACC and the PFA opportunity. I think Sean is best positioned to answer your question, Sean?
Sean Salmon: Yes. Thanks Shagun. So, we have a trial coming out on the six, which will be the very first IDE trial done on the rigors of an FDA trial for a study in this field. So, it’s really the first dataset. And it is two patient populations in the single trial, both paroxysmal patients as well as persistent patients. And the endpoints are primary safety endpoint, primary efficacy endpoint. And the rigorous trial design here under the hospices offices of an IDE trial mean that you have very frequent monitoring the patients, and you get a true kind of look at the way this anatomical solution performs. I would say anatomical solution because we have really two things in this bag of AF treatments. One is one where you isolate the pulmonary veins and then the Affera system allows you to astute point-by-point ablation with a highly differentiated catheter.
That system is an automatic mapping system that allows you to kind of map, ablate and then valuate what you have done, and we will put all of our catheters on to that ecosystem over time, including this anatomical catheter, the as well as cryocatheters. So, we will have a full array of all energies cryo, radio frequency as well as postural ablation to treat a myriad of arrhythmias that occur across the entire space. So, it really does put us on €“ with the newest technology early in the phase of that highly differentiated on both the mapping system as well as the therapeutic catheter side. And there is a lot of excitement among physicians for what we are bringing to the field.
Geoff Martha: Thanks Shagun. Brad, we have got time for two more questions, please.
Operator: The next question comes from Travis Steed at BofA. Travis, please go ahead.
Travis Steed: Hi. Thanks for taking the question. Karen, I do want to ask on the Q4 margin step-up. Q3 was a little bit light on margins from FX and currency. Just curious if there is anything other than improving revenue to drive the Q4 margin step-up? And then I know you are not going to get much on FY €˜24, but curious if you could kind of frame the opportunity on the cost side. I don’t know if there is enough to offset the mid-single digit inflation or partly offset that or more than offset. Just a little bit of color on the cost savings side would be helpful. Thank you.
Karen Parkhill: Yes. Thanks, Travis. So, on Q4 margins, that will be €“ revenue growth obviously helps. So, we will start there. But we also will be driving cost reduction starting last quarter and even more into the fourth quarter, that will help as well. And then Q4 typically is our highest margin quarter. So, we are focused on that step-up and it’s typical for us. On the cost opportunity for FY €˜24, again, we are not going to size it right now. But we have said that we are focused on driving a significant cost reduction to help partially offset the impacts that we have got from the various headwinds and the investment that we need to make.
Travis Steed: Great. Thank you.
Ryan Weispfenning: Thanks Travis. And we will take our final question please, Brad.
Operator: The final question comes from Rick Wise at Stifel Nicolaus. Rick, please go ahead.
