Boston Scientific Lowers 2026 Guidance on WATCHMAN and EP, Hinting Modest 2027 Organic Growth

Boston Scientific updated 2026 guidance: EP & WATCHMAN revisions, and implications for 2027 organic growth

1) What changed in the updated 2026 guidance (the “why”)

Management said the guidance reduction is concentrated in two areas: WATCHMAN and EP. ¹ Specifically, they cite (a) WATCHMAN U.S. market slowing sharply and unexpectedly, tied to compounding clinical evidence that has impacted referral patterns, and (b) EP competitive share movement in the U.S. that they “did not anticipate the degree” of. ¹

They also framed that the dynamics are assumed to continue into 2027, which is why the company expects revenue growth below WAMGR and limited adjusted EPS growth. ¹ They reiterated that they are assuming “the existing market that we’re seeing today does not change” for guidance purposes. ²

2) WATCHMAN revision: what management is now assuming for 2026

2.1 Second-half 2026 (timing + magnitude)

For WATCHMAN, management guided that second-half 2026 would see declines globally in the mid-single-digit to high-single-digit range. ³ They said this is based on a trend they have seen and “[they] have not seen uptick in the first half of the year.” ³

Separately, they also described that the U.S. market assumption implies Q3 sequential decline and full-year growth of flat to low-single digits at the U.S. level for WATCHMAN context, while international remains stronger (about ~20% full-year growth in that same framing). ⁴

2.2 What explains the WATCHMAN call

They emphasized that the WATCHMAN market change has been “dramatic and pretty sudden over the past 6 months.” ² For guidance, they are assuming no benefit from their initiatives to improve the WATCHMAN market. ²

They also acknowledged the practical impact of high comps with concomitants and that in WATCHMAN the issue shows up as “declining stand-alone share” (described as mid-teens growth negative in their discussion of stand-alone growth). ⁵

2.3 WATCHMAN extends into 2027 in management’s base case

When asked about “no improvement in 2027,” management stated they are assuming those dynamics extend into 2027 (i.e., WATCHMAN pressure continues). ¹ They also explicitly said that, for now, they consider the 2027 market prudent to assume is consistent with current trends, with no market-change assumed in the guidance, despite efforts to improve it. ⁵

Additionally, they noted they anticipate share erosion in 2027 from new competition (they referenced a competitor “at some point in 2027”) and said WATCHMAN will be difficult in 2027 absent a market change. ⁵

3) EP revision: what changed and what management is assuming

3.1 Second-half 2026 (timing + directional change)

Management said the second-half guide down is primarily driven by WATCHMAN and EP. ² They further stated that, in second-half 2026, the global Electrophysiology business is guided to be approximately flat growth. ⁶

They also stated earlier in the call that they’re not pleased with the guidance reduction and that it’s primarily driven by EP and WATCHMAN. ³

3.2 Why EP is pressured (share movement + competitive undercall)

For EP, management said they were “quite pleased with the performance in the quarter” and the portfolio road map (Ultra launch “in kind of this time next year,” ICE entry, Ultra platform initiating an IDE). ² However, with specific EP they said they “undercalled the competitive pressures in the U.S. in terms of share taking,” including that they continue to be the PFA leader but their share has come down. ²

They also explained a regional difference in EP market penetration: PFA market accelerated to about 80%–85% of the market share, but “[they] don’t see that” in Europe and Asia, where EP continues to grow about 20%. ² That mix helps explain why the issue is concentrated in the U.S. competitive dynamics rather than a universal demand collapse. ²

3.3 EP improvement is pushed to later in the cycle (2027 second half and 2028)

EP is not treated as structurally impaired in management’s outlook; rather, management expects a rebound later:

• They said EP performance will improve in the second half of 2027 after FARAWAVE Ultra and ICE-market entry, and they referenced additional improvement in 2028 as FARAFLEX becomes available. ⁷
• In response to the 2027 framework question, they indicated they aim for 2027 to do better than their second-half 2026 guide, while assuming WATCHMAN market call stays conservative. ⁸
• They stated they aim to “get back to stronger performance in EP” in 2027 and expressed confidence that “75% of the business, which is growing at 6%” will improve over time with Urology and CRM specifically. ⁸
• They also said they expect EP to be at or above market growth in 2028. ³⁹

4) The implication for 2027 organic growth, given current market trends

4.1 Management’s stated 2027 “framework” (directionality, not a precise point estimate)

Management did not provide a precise 2027 numeric organic growth guide in the excerpted portion; instead, they provided a framework:

• They want to “improve 2027 versus our second half 2026 guidance”. ⁸
• That framework is explicitly conservative on WATCHMAN (assumes no market improvement versus current trends). ⁸²⁵
• They warned that they expect a challenging 2027. ¹⁰

So, the implication is: 2027 organic growth is not expected to re-accelerate to “new high” rates in the base case, because WATCHMAN and EP headwinds are assumed to extend, while EP rebound is delayed to later in 2027 and 2028. ¹⁵⁷

4.2 What the underlying business mix suggests for growth sustainability

They reiterated that ~75% of the business continues to grow ~6%, consistent with 2025, and they expect that portion will improve over time as Urology/CRM strengthen. ¹¹⁸ They also said the challenge is concentrated in EP and WATCHMAN, which had hyper growth earlier and now face more pressure in ’26 and ’27. ³

They also described: “limited EPS growth in 2027” and that this is due to gross margin pressure from continued softness in WATCHMAN and EP (plus initial Penumbra impacts). ¹⁰ While that speaks to EPS more than top-line, it’s consistent with a muted organic growth environment in 2027 rather than a broad-based acceleration. ¹⁰

4.3 Net effect: expect “better than 2H26, but still pressured”

Putting the EP and WATCHMAN pieces together:

• WATCHMAN: management assumes no market change and expects the WATCHMAN decline dynamics to extend into 2027, with possible share erosion from new competitor. ⁵¹
• EP: management expects flat in 2H26, then improvement in 2H27 tied to FARAWAVE Ultra and ICE-market entry, and then stronger improvement in 2028. ⁶⁷
• Management’s explicit 2027 stance is “improve 2027 versus 2H26 guidance” but conservatively (especially on WATCHMAN). ⁸

Therefore, the implication for 2027 organic growth—given management’s assumptions and “existing market” conservatism—is that 2027 organic growth should be expected to be:

1. Incrementally better than the weaker second-half 2026 level, because EP improvement is expected in 2H27. ⁸⁷
2. Still below what it would be in an environment where WATCHMAN market trends improve, because the base case assumes the WATCHMAN market call does not improve and that WATCHMAN remains difficult in 2027. ²⁵⁸

4.4 Relation to the buy-side 5% organic growth expectation mentioned in the call

In the Q&A, a participant stated buy-side is “settling out somewhere around 5% organic growth coming into today,” and asked how management views that heading into the second half. ¹² While the excerpt does not include management explicitly confirming or rejecting “5%” as the final 2027 number, management’s guidance logic supports a mid-single-digit growth pattern rather than a re-acceleration to high-single digits early in 2027:

• For 2026, management guided organic to 5%–6% for full-year (5%–6% organic growth) and 2H26 specifically contemplates EP flat and WATCHMAN mid- to high-single-digit decline. ⁶¹³
• For 2027, they aim only to do better than 2H26 (not to regain a stronger “at market” posture for EP across the whole year immediately), and they assume the WATCHMAN market remains conservative. ⁸⁵

So, under their stated framework, a “around mid-single-digits” organic growth rate in 2027 is directionally consistent with: (i) EP rebound pushed into 2H27, and (ii) continued WATCHMAN pressure. ⁸⁷⁵

5) Bottom line

• WATCHMAN revision (2026): management now assumes mid- to high-single-digit global declines in 2H26, driven by a dramatic market slowdown tied to compounding clinical evidence impacting referrals, and they assume their initiatives do not change the existing WATCHMAN market for guidance purposes. ³²
• EP revision (2026): management guided EP approximately flat in 2H26, attributing the EP headwind largely to U.S. competitive share taking they undercalled, even while they are pleased with execution and the upcoming Ultra/ICE roadmap. ⁶²
• Implication for 2027 organic growth: management’s base-case framework is conservative on WATCHMAN (assuming no market improvement and anticipating share erosion with new competition), while expecting EP improvement in 2H27 tied to FARAWAVE Ultra and ICE entry, aiming only to improve 2027 versus 2H26 guidance rather than to assume an immediate broad re-acceleration. ⁸⁵⁷