Greetings, and welcome to the Pulse Biosciences Fourth Quarter 2023 Earnings Conference Call. At this time, all participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. [Operator Instructions] As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Philip Taylor, Investor Relations. Thank you, sir. You may begin.

Thank you, operator. Before we begin, I would like to inform you that comments and responses to your questions during today's call reflect management's views as of today, March 28, 2024 only and will include forward-looking statements and opinion statements, including predictions, estimates, plans, expectations and other similar information. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are more fully described in our press release issued earlier today and in our filings with the U.S. Securities and Exchange Commission. Our SEC filings can be found on our website or on the SEC's website. Investors are cautioned not to place undue reliance on forward-looking statements. We disclaim any obligation to update or revise these forward-looking statements. We will also discuss certain non-GAAP financial measures. Disclosures regarding these non-GAAP financial measures, including reconciliations with the most comparable GAAP measures can be found in the press release. Please note that this conference call will be available for audio replay on our website at pulsebiosciences.com in the News and Events section on our Investor Relations page. With that, I would now like to turn the call over to President and Chief Executive Officer, Kevin Danahy.

Thank you, Trip. Good afternoon, everyone, and thank you all for joining us on this call. I am excited to be here today with our team, including Darrin Uecker, Chief Technology Officer and Director; Mitch Levinson, Chief Strategy Officer; and Mike Koffler, Vice President of Finance. Our accomplishments in 2023 and early this year have been focused on our proprietary designed and engineered CellFX nsPFA energy delivery system and the 3 novel endofactor devices designed to deliver our CellFX nsPFA energy to different tissues in the body. We are pleased with our success. Today, I will highlight each of the 3 surgical opportunities we are currently focused on at Pulse Biosciences. The CellFX nsPFA percutaneous electrode, the nsPFA surgical clamp and the nsPFA 360-degree cardiac catheter. I will then hand the call over to Darrin to provide a detailed product update on our cardiac device programs, and then Mitch will provide specific noncardiac development progress. Finally, Mike will review our fourth quarter and end of year 2023 financial results before I conclude and open the call for a question-and-answer session. First, I want to focus on the CellFX nsPFA percutaneous electrode. The percutaneous electrode or PERC electrode is designed for the surgical soft tissue ablation, leveraging our proprietary design and engineered CellFX nsPFA energy delivery system. The CellFX nsPFA energy creates potential patient benefit and surgeon value in the treatment of soft tissue nodules. We believe CellFX nsPFA has the potential to provide hospitals and treating physicians with a new and exciting alternative for patients with a broad range of soft tissue nodules in need of therapy. In November 2023, Dr. Stefano Spiezia, leading thyroid surgeon and Chief of Endocrine Surgery division at Napoli Ospedale del mare in Naples, Italy, completed our initial trial of 30 patients on the application…

Thank you, Kevin. In the fourth quarter and in recent months, we are continuing to make significant progress advancing our cardiac catheter and clamp programs. Data generated from our recent studies have continued to validate our expectations that the differentiated benefits of our CellFX platform and proprietary devices that leverage the novel characteristics of nsPFA technology and the CellFX system positions us to be the next-generation standard of care for the treatment of AF as well as other indications. Let me highlight again the important differences between our nanosecond PFA and existing microsecond PFA technologies. The higher amplitude and shorter duration of nsPFA energy pulses are uniquely able to penetrate the cell membrane and alter the function of cellular organs, leading to regulated cell death rather than immediately destroying cells like most other energy modalities, such as standard PFA and thermal modalities like cryo, which uses extreme cold, or radio frequency ablation, which uses extreme heat. NsPFA delivers about 20 times less energy over time to tissue than standard PFA. Because microsecond PFA delivers so much relative overall energy, these devices tend to operate close to the threshold of time-based thermal energy injury. So it is necessary to trade off speed, depth of penetration and the amount of tissue that can be treated at once to ensure safety. Our early data show that the CellFX nsPFA nonthermal mechanism of action can lead to beneficial outcomes in the clinical setting where physicians do not need to trade at efficacy to ensure safety. We are developing CellFX nsPFA cardiac ablation solutions for use in open surgery by cardiothoracic surgeons and for use in the electrophysiology labs by electrophysiologists making us the only company we're aware of developing nanosecond pulse field products for both applications. I will first provide progress on our initial…

Thanks, Darrin. We continue to believe that CellFX nsPFA energy will broaden treatment horizons for many applications with its unique and effective mechanism of action, as Darrin outlined. As Kevin mentioned, we recently received FDA 510(k) clearance for our proprietary CellFX nsPFA percutaneous electrode system for use in the ablation of soft tissue in percutaneous and intraoperative surgical procedures. This clearance represents our entrance into a new set of clinical applications where our technology can improve the standard of care. The CellFX nsPFA percutaneous electrode system consists of a percutaneous needle electrode, powered by our proprietary designed and engineered CellFX nsPFA energy delivery system. This percutaneous electrode is intentionally designed for noncardiac tissue ablation applications. As we have mentioned, we have numerous soft tissue ablation targets in the process of evaluation, one of which is benign soft tissue nodules. As we previously discussed, the standard of care for benign thyroid nodules is thyroidectomy. Removal of part or all of the thyroid gland, which comes with surgical risks, visible scarring and often lifelong hormone replacement therapy. Thermal ablation using radio frequency or microwave or other treatment options, but carry with them the risks of collateral thermal damage to nerves, vessels, the esophagus, trachea and skin. For these reasons, many patients with unwanted benign soft tissue nodules forego surgery or thermal ablation and simply choose to live with the condition. We believe Pulse Biosciences and this PFA technology can potentially bridge the watchful waiting gap and potentially service these unmet needs. We've completed enrollment of 30 patients in our Italian study of patients with benign thyroid tumors with our nsPFA percutaneous electrode using ultrasound guidance. The procedures we performed appeared to be comfortable for patients with little or no reported post-procedural pain or swelling. We are continuing to conduct patient follow-ups at…

Thank you, Mitch. Moving down the income statement, I'll focus my comments on our non-GAAP results. I encourage you to review today's earnings release for a detailed reconciliation of non-GAAP measures to the most comparable GAAP measures. In the fourth quarter of 2023, non-GAAP total cost and expenses increased by $1.2 million to $8.9 million compared to $7.7 million in the prior year period. The increase in total costs and expenses was primarily driven by an increase in research and development expenses to support the advancement of our CellFX nsPFA devices. Non-GAAP net loss in the fourth quarter of 2023 was $8.3 million compared to $8.1 million in the prior year period. Cash and cash equivalents totaled $44.4 million as of December 31, 2023, compared to $50.4 million as of September 30, 2023. Cash used in the fourth quarter of 2023 totaled $6.9 million and was reduced compared to $8 million used in the same period in the prior year and $8.7 million used in the third quarter of 2023. Earlier today, the company filed a universal shelf registration with the SEC. We believe maintaining a shelf is consistent with good corporate practices for a public company. I will now turn the call back over to Kevin.

Thank you, Mike. I will now provide some closing remarks. As we continue in 2024, our focus as a company is to continue building on the momentum of 2023. With the recent 510(k) FDA clearance for the percutaneous electrode, it is our intention to further create the internal and external architecture and support amongst KOLs to ensure and enhance our adoption campaign. To fund our future operations, as detailed in the press release, the company has filed a preliminary registration statement with the U.S. Securities and Exchange Commission, the SEC, to establish a universal shelf pursuant to which, once it is effective, the company may from time to time sell an aggregate of $50 million worth of its common stock, preferred stock, depositary shares, warrants, debt securities or units. Additionally, early today, the company announced that the Board of Directors has approved rights offering of up to $60 million worth of units available to all holders of record of the company's common stock as of the close of the market on the recorded date in April to be announced as soon as practicable. Each unit will consist of one share of common stock and warrants to purchase a total of one share of common stock. The subscription price per unit shall be equal to the lesser of a, $10 per unit, which we will refer to as the initial price or b, the 10-day VWAP of the company's common stock immediately prior to the expiration date of the offering. VWAP is a volume-weighted average price. The subscription price will determine the final number of units issuable and subsequently, the pro rata number of units to which a stockholder can subscribe. Each warrant will have a per share exercise price equal to 110% of the subscription price for the unit. The…

Thank you, Kevin. Now we're going to address a few questions we've received over e-mail. Then we'll open up the line for questions from the audience. . The first question is, what is the time line for the commercialization of the percutaneous electrode? What are your revenue expectations for this year?

This is Mitch. I can take that one. So this percutaneous electrode with its general ablation clearance is going to be useful for a lot of soft tissue applications. But as I mentioned, the primary application we're going to start with is in benign thyroid nodule ablation. This technology is highly differentiated. It's brand new to the space. It's going to be disruptive. And so what we're going to be doing -- first thing is to be working with our key opinion leaders who are experts in ultrasound-guided percutaneous ablation. We're going to be optimizing the procedure. We're going to be working towards ideal outcomes. We're going to ensure that this procedure is reproducible, it's teachable. We're going to be building our internal or external structures and as soon as we understand all of those and have all those pieces in place, and we've got our structure, we're going to be hitting the gas and we're going to be accelerating. We're very excited to get this product out as soon as we're ready to -- into as many patients as we can. And we're looking forward to updating you on a quarter-over-quarter basis, and we'll keep you posted.

And Mitch, I'll just jump in, just to add a little bit more. We have been working extensively on the internal and external architecture to support this 510(k) clearance, and we're excited to report that we have many surgeons that have reached out to us. We've been working with them. And again, we're just putting that architecture in place that we can show that it's reproducible and teachable and we know it's better than existing technology to get it out there, and we will update on a quarterly basis on where we stand.

The next one is, can you provide more detail on the first in-human study for the cardiac clamp?

This is Darrin. I'm happy to do that. Yes, we announced today that we're going to be doing a first in-human feasibility study starting in the middle of the year. And really, this is just in response to a couple of things. Number one, just the substantial interest that we've had from cardiac surgeons on this clamp and this new technology and their high interest in getting it into the clinic. And really, based on all the success we've had with our catheter feasibility study as well as the success with our percutaneous electrode and the feasibility study that we did with that, we just felt like the time was now to do a first-in-human study feasibility study with our clamp. And so we're well on our way to doing that. We have to go through the regulatory bodies to get the study approved. We expect to do that outside the U.S. And again, we're going to do that starting in the middle of the year. So it's really just based on all the excitement around it and the success we've had running feasibility studies with some of our other devices.

The next question is you mentioned using the EnSite and Carto systems with the catheter. Can you elaborate on the mapping integration strategy?

This is Darrin again. So I think we -- with our catheter, the goal is to make sure that physiologists have well-integrated solution in their labs to be able to treat their patients effectively. And so we listened to those electrophysiologists and try to understand what kind of tools they need, what kind of tools they're using and we want to be compatible with all those tools. So we started in our feasibility study with our catheter integrated with mapping and navigation and have seen what we think are very encouraging results. In conversation with a number of the EPs who have been involved with that, they requested that we work on integrating with other mapping and navigation systems to really create a system where we can be compatible with almost every EP Lab that's in the world today. So -- there are several mapping and navigation systems out there. There are a couple, which we've talked about that sort of dominate this space, in particular, the Carto system from J&J and the EnSite system from Abbott. And so it's incumbent on us to work to be compatible with those systems so that we can provide EPs with fully integrated solutions to treat their patients. So that's our current strategy.

Operator, let's now open the line from questions from our listeners.

[Operator Instructions] Our first question comes from Anthony Petrone with Mizuho Securities. Please proceed with your question.

Brad Bowers on for Anthony today. Just wanted to kind of hear first off about the thyroid indication. It seems like you kind of have a pretty broad indication there with the recent approval. So I wanted to kind of hear more about the strategy of going after the thyroid market first. Is it something about the size of the market, the opportunity versus incumbents or something about these venture in the market. I just wanted to hear about that.

Thanks, Brad. This is Mitch. Thanks for that question. Yes, the thyroid nodule, benign thyroid nodules in particular represents a very large market that we believe is mostly untapped because the technology has not really been there to meet that unmet need. And it also is a -- it's a nice benign tumor that is well performed by our technology in a -- with ultrasound guidance. And it's a really good step forward out into soft tissue ablation in the tumor. So that's why we've decided to start there. And then we expect that people in parallel with that and subsequently after we have got some initial experience, we'll be using this in all sorts of soft tissue applications.

This is Bob Duggan. Let me make a comment here. We have clearance from the FDA with regard to soft tissue ablation. We do not have a specific label for thyroid. Thyroid falls under the umbrella of soft tissue ablation. So it is customary in this business for the treating physician to choose the soft tissue that they would like to approach. So everything else is as Mitch laid it out, but we want to make very sure we're not claiming that we have a clearance for thyroid, but soft tissue includes thyroid. So we will -- we market this in the direction of soft tissue ablation clearance.

And then one just on the clamp product. Just wanted to kind of hear about some of the commercialization plans that you can kind of do here while the submission is underway. You talked about some of the advantages versus the incumbent technologies. So I just wanted to kind of hear about your view of the opportunity and how you think about taking advantage of that out of the gate here?

This is Kevin. Thank you for the question. As same with the percutaneous electrode, we continue to look at the internal and external requirements that are going to be needed to launch any of our products. And one of the things that we take very serious is just, what is the architecture of support that is going to be needed in the operating room. And some of our predecessors might be there for all cases. We want to be in a place that we put a program in place that allows the account to absorb the information is talk correctly and that we can have a walk away that we've transferred the knowledge over to them to empower them to do the cases on their own. So as we build out our architecture, we want to be very aware of what is needed in order for them to become really secure in the procedure and then what is going to be needed on an ongoing basis. So those are still in design as we work with the FDA for clearance with the clamp specifically, but the same type of philosophy that we're going to use with all indications that we bring.

[Operator Instructions]. It appears that there are no further questions at this time. I would now like to turn the floor back over to Kevin Danahy for closing comments.

Thank you, operator, and thank you all for joining us today. As we reflect on 2023 and we look to 2024, we're extremely proud of the accomplishments that we've had and the milestones that we've achieved, but we know that we're just at the beginning of this journey. And we're excited that you've all decided to take this journey with us. Nanosecond pulse field ablation is a paradigm shift and we believe that this energy is going to change the way that surgery is done in multiple domains and we're excited to bring that update to you on a quarter-to-quarter basis. So please stay tuned, stay on this journey with us. There's tremendous excitement coming, and we're excited that you're all part of this. So thank you for joining on this call today, and we look forward to talking to you soon.

This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.