Cardiovascular is the fastest-growing segment in medical device right now.
This week we cover what is happening in it, what the commercial opportunity looks like, and how to break into one of the most meaningful careers in this industry.
THE EDITOR’S NOTE
A few thoughts from the field before we get into it…
I have spent most of my career in orthopedics and sports medicine. I know what it feels like to watch a patient walk out of the hospital on a new knee, or see an athlete return to the field after a reconstructive procedure. Those moments matter. But cardiovascular is a different category of stakes entirely.
When something goes wrong in the heart, the margin for error is not measured in recovery time or rehabilitation weeks. It is measured in minutes. Someone's heart stops and the window closes fast. That reality shapes everything about how cardiovascular device professionals work, what they know, and what is expected of them in the field.
I do not have a cardiovascular sales background. But I understand what this segment means in a very personal way. About fifteen years ago, my father had a heart attack and underwent emergency triple bypass surgery. I was living far from home at the time and had to get on a plane, not knowing what I would find when I landed, and not knowing whether my father would make it. I flew home to be with my mother, to be there for whatever came next.
He made it. He had several more good years after that, and I will always be grateful for that time. But sitting on that plane, and then sitting with my mother waiting for news, gave me a perspective on this industry that no amount of time in an OR ever could. The people and the devices on the other side of those doors were not abstractions. They were the reason my father came home.
Cardiovascular is one of the most technically demanding, highest-compensated, and most meaningful segments in medical device. This week we go deep on what is happening in it, where the opportunity is, and what it takes to build a career here.
Glad you're here. Let's get into it.
Andy Knapik, Founder
The Modern Med Rep
INDUSTRY INTEL
What's moving in med device this week and why it matters
Five Things Shaping the Industry Right Now
→ Medtronic's cardiac ablation business grew 80% — 137% in the U.S. — on the strength of pulsed field ablation.
Cardiac Ablation Solutions was the standout performer in Medtronic's most recent earnings, driven almost entirely by the rapid adoption of PFA technology. The Sphere-9 catheter is proving effective across both simple and complex cases. As we covered in Issues #001 and #002, PFA is rewriting the electrophysiology playbook — and these numbers show exactly how fast that rewrite is happening.
→ The FDA exempted radiology AI detection devices from standard premarket notification requirements.
Computer-aided detection and diagnosis devices for radiology, and computer-aided triage and notification devices, are now exempt from 510(k) premarket notification. This lowers the regulatory barrier for AI diagnostic tools in imaging, which will accelerate commercialization of a category we covered in Issue #004. For anyone in imaging or diagnostics sales, expect more AI-powered tools entering your market faster.
→ The Section 232 medical device tariff investigation is still unresolved but the outlook has improved.
The investigation, which could have resulted in significant tariffs on the 62% of devices used in the U.S. that are manufactured overseas, has not produced major new tariff actions against medtech so far. Industry analysts now suggest the Trump administration is unlikely to single out medical devices for punitive tariffs, though uncertainty remains. The Section 232 probe has been a background concern for device companies throughout 2026 and is worth tracking as it moves toward resolution.
→ Intuitive published a new meta-analysis showing better patient outcomes for robotic surgery across 13 conditions.
A September 2026 meta-analysis showed statistically significant improvements in patient outcomes associated with da Vinci surgery versus laparoscopic and open surgery across 13 common benign surgical conditions. For anyone in robotic surgery sales, this is the kind of clinical validation data that changes conversations with hospital administrators and surgeons who are still evaluating whether robotic-assisted procedures justify the cost.
→ CMS (Centers for Medicare and Medicaid Services) proposed expanding Medicare coverage for TAVR, and Boston Scientific invested $1.5 billion in a new TAVR competitor.
TAVR, or transcatheter aortic valve replacement, is a minimally invasive procedure that replaces a damaged aortic heart valve by threading a new valve through a catheter, typically through the femoral artery, without open-heart surgery. It transformed structural heart care by making valve replacement accessible to patients too high-risk for traditional surgery, and has since expanded to lower-risk patients as well. CMS recently proposed covering TAVR for asymptomatic severe aortic stenosis patients and removing previous volume requirements, significantly expanding the eligible population. Separately, Boston Scientific invested $1.5 billion in MiRus LLC, which is developing the SIEGEL balloon-expandable TAVR system, with an exclusive option to acquire it. Boston Scientific has been largely absent from the TAVR market. That may be about to change.
MARKET SPOTLIGHT
A deep dive into the segments, companies and technologies shaping the industry
Cardiovascular Device: The Fastest-Growing Segment in Medtech Right Now
Cardiovascular device is not one market. It is a collection of distinct clinical specialties, each with its own procedures, customer relationships, and commercial dynamics.
Understanding how the segment is organized is the first step toward figuring out where you fit in it.
Electrophysiology. EP is the sub-segment generating the most commercial activity in cardiovascular right now. Electrophysiologists are the specialists who diagnose and treat heart rhythm disorders, called arrhythmias, using catheters threaded through blood vessels into the heart. The dominant procedure is catheter ablation, which destroys small areas of heart tissue that are causing abnormal electrical signals. Pulsed field ablation, or PFA, is the newest and fastest-growing technology in this space. Instead of using heat or cold to destroy tissue, PFA uses electrical pulses that selectively affect heart tissue while leaving surrounding structures intact. That selectivity translates to fewer complications and faster procedure times, which is why hospitals and physicians are adopting it at a rate that is unusual even by medtech standards. Boston Scientific, Medtronic, Abbott, and J&J's Biosense Webster all compete actively in this space.
Structural heart. Structural heart involves devices that repair or replace the physical structures of the heart: valves, walls, and openings. TAVR has been one of the most significant commercial success stories in cardiovascular device over the past decade, replacing open-heart surgery for aortic valve disease in patients too high-risk for traditional surgery and increasingly in lower-risk patients as well. Left atrial appendage closure, a procedure to reduce stroke risk in atrial fibrillation patients by closing off a small pouch in the heart where clots can form, is a fast-growing adjacent category. Edwards Lifesciences, Abbott, and Medtronic are the dominant TAVR competitors, with Boston Scientific now making a move into the space through its MiRus investment.
Cardiac rhythm management. CRM covers pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy devices, which help the heart beat in a more coordinated rhythm. This is a mature, high-volume market with consistent demand driven by an aging population. Medtronic, Abbott, and Boston Scientific are the three dominant players. Remote monitoring, which allows physicians to check device function without an in-person visit, is a growing component of the commercial conversation.
Cardiac monitoring. Cardiac monitoring covers devices that detect and record abnormal heart rhythms over extended periods, typically in patients who have symptoms too infrequent to catch during a standard office visit. As we covered in Issue #010, iRhythm's Zio patch and its recent acquisition of VitalConnect reflect how significant this segment has become. The commercial model is closer to digital health, involving subscription-based revenue and conversations with physician practices and health systems about workflow integration and reimbursement.
Interventional cardiology and vascular. This broad category covers the devices used in the cardiac catheterization lab for everything from coronary stenting to peripheral vascular interventions. Interventional cardiologists are among the highest-volume proceduralists in the hospital, and the cath lab is one of the most active commercial environments in all of device. Boston Scientific, Abbott, Medtronic, and Teleflex all have significant commercial presences here.
The commercial reality of cardiovascular:
Cardiovascular is the segment where the clinical stakes are highest, the physician relationships are deepest, and the commercial rewards are strongest. Top cardiovascular reps consistently rank among the highest earners in the device industry, with experienced EP and structural heart reps routinely earning $300,000 to $500,000 or more. The bar to get there is real. But so is the ceiling.
CAREER OPPORTUNITIES
Where the jobs are, what’s paying, and how to position yourself to get there
Breaking Into Cardiovascular Device: What You Need to Know
Industry Foundation: If you are targeting a cardiovascular role, understanding the difference between an EP lab, a cath lab, and a cardiac OR will help you speak the language before your first interview.
The electrophysiology lab, or EP lab, is where arrhythmia procedures are performed using catheters and mapping systems. The cardiac catheterization lab, or cath lab, is where interventional cardiologists perform coronary and vascular procedures: stenting, valve work, and diagnostic catheterizations. The cardiac OR is where open-heart procedures like bypass surgery and surgical valve replacement happen. Each environment has different reps working in it, different companies competing, and different clinical knowledge requirements. Knowing which environment a role is based in, and what the clinical workflow looks like there, signals to a hiring manager that you have done the work before walking in.
The Med Device Career Decoder covers how different clinical environments work and what they mean for the commercial role. Find it at themodernmedrep.com.
Cardiovascular is one of the harder segments to break into from outside the industry. The clinical knowledge bar is high, the physician relationships take years to build, and most companies prefer candidates who have some clinical or device experience. That said, people break in every year. Here is how.
The clinical specialist track. The most common entry point into cardiovascular device for someone without existing device experience is through a clinical specialist or clinical support role. These positions involve supporting procedures in the lab, troubleshooting devices, and educating clinical staff. Companies hiring for these roles typically look for backgrounds in cardiac nursing, cardiovascular technology, electrophysiology technology, or related clinical fields. If you have spent time in a cath lab or EP lab as a nurse or tech, you are already positioned for this track.
Remote patient monitoring. Companies like iRhythm, Dexcom, Abbott, Philips, and a growing number of startups are building commercial teams to sell and support RPM platforms. These roles typically involve hospital systems and physician practices as customers and require both clinical credibility and comfort with subscription-based commercial conversations. Clinical backgrounds in cardiology, endocrinology, and pulmonology are particularly valued.
The pharma-to-device crossover. Pharmaceutical sales reps who call on cardiologists are among the most natural candidates for cardiovascular device roles. You already have physician relationships in the right specialty, you understand the cardiovascular clinical environment at a conceptual level, and you have demonstrated the ability to navigate a complex, regulated sales process with demanding customers. The gap to close is procedural and product knowledge, which companies will typically train. This transition is common and well-understood by cardiovascular device hiring managers.
Where the active hiring is right now. PFA is generating the most new commercial team builds in cardiovascular. Boston Scientific, Medtronic, Abbott, and J&J are all expanding EP commercial teams to support PFA adoption. Structural heart is also actively hiring, particularly around TAVR and left atrial appendage closure. The cardiac monitoring segment, including iRhythm post-VitalConnect acquisition, is building out its commercial and clinical support infrastructure. Any of these three areas is a strong target for someone trying to break into cardiovascular device in the next twelve months.
Compensation. Entry-level clinical specialist roles in cardiovascular typically start in the $70,000 to $90,000 range with a path toward full territory responsibility. Territory reps in EP and structural heart with two to five years of experience earn $150,000 to $250,000 in total compensation. Senior reps with established physician relationships in high-volume markets regularly earn $300,000 to $500,000 or more. Cardiovascular is consistently one of the top two or three segments in device for total earnings potential.
The one thing that matters most in cardiovascular:
Credibility under pressure. These procedures are high-stakes, fast-moving, and technically complex. The reps who earn the deepest physician relationships in this segment are the ones who can be counted on in a difficult case, who know the technology cold, and who never get in the way. Building that reputation takes time. Starting to build it earlier than everyone else is the only real shortcut.
THE MED INSIDER
One thing every med device professional should know this week
What PFA Actually Is and Why It Matters So Much Right Now
Pulsed field ablation has been mentioned in this newsletter since Issue #01. At this point it is the single most commercially significant technology story in cardiovascular device, and it deserves a plain-language explanation for anyone who has not had a chance to dig into it.
Here is the context. Catheter ablation for atrial fibrillation has been performed for decades. The basic idea is to destroy small areas of heart tissue, specifically around the pulmonary veins, that are triggering abnormal electrical signals and causing the heart to beat erratically. The traditional methods use heat, called radiofrequency ablation, or cold, called cryoablation, to create the lesions that block those signals. Both methods work. Both also carry risks related to the fact that heat and cold do not discriminate perfectly between heart tissue and the surrounding structures, including the esophagus, which sits directly behind the heart.
Pulsed field ablation is different. Instead of heat or cold, PFA delivers precise electrical pulses that cause targeted cell death through a process called electroporation. Heart muscle cells are particularly sensitive to these pulses, which means PFA can create effective ablation lesions while largely sparing the surrounding tissue. The esophageal injury risk that has long been a concern with thermal ablation is significantly reduced. Procedure times are also shorter, which matters both clinically and operationally for a cath lab trying to manage a high-volume schedule.
The commercial impact of these advantages has been dramatic. Boston Scientific's FARAPULSE system was the first PFA system to receive FDA clearance in the U.S. and quickly became one of the fastest-adopted technologies in the company's history. Medtronic's entry with its Sphere-9 catheter drove 80% overall revenue growth and 137% growth in the U.S. in its most recent quarter. Abbott and J&J are building out their own PFA portfolios. The entire EP ablation market is in the middle of a technology transition, and the commercial opportunity attached to it is enormous.
Why this matters for job seekers:
If you are targeting any role in electrophysiology device right now, you need to be able to speak to PFA fluently. Not at an engineering level, but at a clinical and commercial level. What it is, why it is better than thermal ablation for certain patients, which systems are cleared, and why hospitals are adopting it. Walking into an EP-related interview without this knowledge is the equivalent of interviewing for a robotic surgery role without knowing what da Vinci is.
FROM THE FIELD
Your Questions, Answered
This week's question comes up constantly from pharma reps trying to make the move:
"I have been in pharmaceutical sales for four years, calling on cardiologists.
I want to move into cardiovascular medical device.
How realistic is that and what do I need to do to make it happen?"
It is very realistic, and your background is genuinely valuable for this move. Four years calling on cardiologists means you already have relationships in the right specialty, you understand how cardiologists think and how their practices operate, and you have demonstrated the ability to sell to one of the more demanding physician groups in medicine. That is not nothing. Device hiring managers in cardiovascular know exactly what pharma reps bring to the table.
The gap you need to close is procedural knowledge. Pharma reps sell to cardiologists in their offices and clinics. Device reps work inside the cath lab and EP lab, supporting procedures in real time. That environment is different from anything you have experienced in pharma, and companies know they will need to train you on it. What you need to demonstrate is that you understand the difference and are genuinely prepared for it, not just interested in a pay increase.
The most practical steps: learn PFA cold, because it is the hottest topic in cardiovascular device right now and being able to speak to it fluently signals that you are serious. Ask one of your cardiologist contacts if you can observe a procedure in the cath lab or EP lab. Even a single observation visit changes how you talk about the environment in an interview. And target companies that are actively building EP and structural heart teams right now — Boston Scientific, Medtronic, Abbott, and J&J are all in expansion mode. Your physician relationships in cardiology are a competitive advantage. Lead with them.
Have a question? Reply to this email. The best ones make it into the next issue.
QUOTE OF THE WEEK
“The human heart has a left side and a right side.
But it has only one purpose.”
- Anonymous
