Boston Scientific: Impressive Farapulse Safety Data Sets High Bar for Competitors

Narrow-moat Boston Scientific’s BSX long-awaited clinical data on its Farapulse pulsed field ablation, or PFA, device for atrial fibrillation didn’t disappoint, and we’ve raised our fair value estimate to $55 per share to reflect both our estimates for higher electrophysiology growth, as well as cash flows realized since our last update.

In the heated race toward pulsed field ablation, Boston’s ADVENT study provided the first peek into how PFA stacks up to traditional atrial fibrillation, or AF, ablation platforms that rely on energy from thermal temperature to disrupt the areas of the pulmonary vein that are often responsible for atrial fibrillation. As we’d expected, efficacy of Farapulse is comparable, but not superior, with that of radiofrequency and cryo ablation. Importantly, however, patients who received Farapulse ablation experienced significantly fewer complications with pulmonary stenosis—an after effect of AF ablation that can lead to stiffening of the pulmonary vein that can impede blood flow. In the study, roughly 12% of those receiving thermal ablation saw this condition emerge, while only 1% of Farapulse patients saw the same. We think these results strongly suggest Farapulse offers a meaningful safety advantage over existing thermal options.

At this point, it’s not clear that competitive PFA systems can offer similar efficacy or safety performance. There are enough differences in these technology platforms that they may perform differently. Nonetheless, Boston’s impressive Farapulse safety data on pulmonary vein stenosis sets a high bar for competitors, in our view.