Boston Scientific Revises 2026 Guidance Amid Watchman, Urology, and EP Headwinds

Summary: Why Boston Scientific revised 2026 revenue and EPS guidance (EP WATCHMAN Urology headwinds)

Boston Scientific said the company is lowering 2026 full-year guidance because 2026 is “more challenging” than initially expected, reflecting “unanticipated headwinds and changing business patterns” that they would “cover in more detail.” ¹ The headwinds tied specifically to EP / WATCHMAN / Urology were described as three main contributors to the guide-down: (1) weakening WATCHMAN volume trends in early 2026, (2) EP headwinds (including competitive dynamics/share pressure within PFA), and (3) Urology underperformance in Q1 with expectations it will remain below market in 2026. ²³

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1) WATCHMAN: Practice-pattern shift and decelerating stand-alone volumes

Boston Scientific explained that it saw a change in WATCHMAN demand beginning in early to mid-February, after strong 2025 momentum (they cited ~30% growth in 2025 and strong early-January trends). ² They indicated there is “no signal” of WATCHMAN weakness until those early-February declines, which then informed their decision to assume continued softness within the guidance period. ²

Key WATCHMAN mechanics Boston Scientific cited

• Stronger concomitant growth but decelerating stand-alone WATCHMAN: they said there was “a strong increase in concomitant growth in a deceleration of stand-alone WATCHMAN,” and that this pressure flows through into the guide. ²
• Drivers behind stand-alone weakness (what they described as “multifactorial”):
  • a switch toward EP vs. interventional cardiologists because interventional cardiologists are “less exposed to the concomitant procedure,”
  • reimbursement cut in that area, and
  • some hospital operational workflow changes (new labs, moving to ASCs, and adapting to procedural prioritization). ⁴
• U.S. volume pressure as the quarter progressed, consistent with:
  • annualization of the initial concomitant adoption tailwind, and
  • softening in stand-alone WATCHMAN cases attributed to “hospital capacity related procedure prioritization” and “evolving reimbursement dynamics.” ⁵

Resulting guidance impact

• They said WATCHMAN grew organically in Q1 but was “below our expectations,” with volume pressure developing as the quarter progressed. ⁵
• They indicated for full-year 2026: global WATCHMAN growth is now expected to be mid-teens and low to mid-teens in the U.S. ⁵

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2) EP (Electrophysiology): Competitive dynamics driving share pressure in PFA

Although management emphasized EP still growing strongly, they explicitly tied the revision to increased competition and somewhat more share erosion than anticipated within their PFA platform.

What changed vs prior expectations

• They updated their outlook by saying:
  • they now expect global EP business to grow ~10% in 2026, and
  • U.S. full-year expected EP growth is being updated to the mid-single-digit range, while international remains strong (about plus 20%, inclusive of a stated ~$35 million impact from discontinuation of POLARx). ⁶
• They stated the guide change “reflects ongoing competitive dynamics” and acknowledged that they now expect “a bit more share [erosion] than we anticipated earlier in the year.” ⁶⁷
• They identified specific competitive pressure in PFA:
  • Medtronic as a “solid competitor,”
  • J&J “enhancing their footprint,” and
  • Abbott in “early stages of launch” in the U.S. ⁷

How they positioned EP’s near-term operating reality

• They noted they are still highly confident in maintaining PFA leadership through commercial investment and clinical evidence, but the forecast embeds that competitive pressure will be stronger than previously expected. ⁷
• They also stated that EP (PFA) was strong in Q1—e.g., EP organic sales grew 22% in the quarter (18% U.S., 30% international)—yet the full-year guide still got revised because of competition/share erosion expectations. ⁶

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3) Urology: Q1 underperformance plus expectation of a “below market year” in 2026

Management was explicit that the Urology headwind was not just temporary; they said they were “not happy” with Urology’s quarter and expect 2026 to be weaker than market.

Q1 problem: “difficult” quarter and underperformance drivers

• They said MedSurg/EP commentary included “some EP… challenges right now in Urology” and they were “not happy” with 1% growth in the quarter. ⁸
• They then described Urology’s Q1 performance more specifically: Urology sales grew 1% organically, “falling short of our expectations,” driven primarily by:
  • stone management, and
  • single neuromodulation businesses. ⁹
• Within Stone, underperformance was driven by:
  • China VBP, and
  • “some key product gaps in the core Stone portfolio.” ⁹

2026 expectation: improvement, but still low and below market

• They said they expect Urology performance to improve through the year due to execution plans, including hiring/training new sales/clinical reps and addressing commercial model stabilization. ¹⁰
• However, they lowered the full-year uro expectation to low to mid-single digits growth in 2026. ¹⁰
• They further clarified that Urology is expected to be “essentially going to be a below market year in urology.” ³

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Bottom line: How these EP/WATCHMAN/Urology headwinds flow into the guidance revision

Boston Scientific’s guidance reduction was framed as prudent given these identifiable demand and competitive issues:

• WATCHMAN: volume trend weakening after early-February, with stand-alone deceleration amid stronger concomitant growth, plus U.S. pressure linked to annualization, hospital capacity/workflow prioritization, and reimbursement dynamics. ²⁵⁴
• EP: PFA growth remains strong (EP organic growth was 22% in Q1), but the full-year view embeds increased competition and more share erosion than expected, moving U.S. EP growth expectations to the mid-single-digit range while keeping international stronger. ⁶⁷
• Urology: Q1 underperformance (1% organic growth) tied to stone and neuromodulation issues (including China VBP and product gaps) plus an expectation for 2026 to improve but still be low to mid-single digit and below market. ⁸¹⁰³⁹

These combined EP/WATCHMAN/Urology headwinds were explicitly cited as key “three main contributors” behind the overall guide-down. ²³

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