Yeah. And although WATCHMAN procedures are largely deferrable, patients seeking this therapy are eligible based on their need for an alternative to blood thinners, and physician operators we've surveyed are confident that postponed procedures will be rescheduled when facility capacity and/or protocols allowed for increased elective procedures. And I think most importantly, as procedure volumes get back, it's really about the portfolio that we have. So it's pretty clear based on your internal budgeting, you're forecasting growth in the fourth quarter. We're working hard to strike the right balance of short-term actions to reduce costs while preserving the development of the long-term portfolio and pipeline to enable us to capitalize as the recovery gains momentum. And in terms of growing faster than peer group, that remains the goal, and we aim to continue to deliver that once the recovery happens, and we have the pipeline to do that. And how do you think that new procedures will be prioritized by physicians and the sales team as we come out of COVID? In single-use scopes, the EXALT-D launch is progressing, albeit slowly, due to COVID-restricted hospital access and capacity.

Mike, I just had a couple here on recovery.
Dan Brennan -- Executive Vice President and Chief Financial Officer. We're humbled to be able to continue to serve our customers, patients, employees and community needs in the COVID-19 pandemic. Our EP recovery will be driven by our strengthening portfolio, including POLARx, which is our second-generation single-shot cryoablation catheter that will resume its European launch in Q3 when access to labs improves. First one is on your comments on cost cutting.

So many of our key R&D programs are still in flight. So obviously, we saw in Asia, particularly in China, we had the impact that started in January, but for the U.S. and EMEA and unaffected areas in Asia Pac, things were going pretty nicely. Yeah. I wanted to just ask about Japan. We've also leveraged our capabilities to develop countermeasure technologies, such as the Coventor personal respirator, which was developed and approved in just four weeks, as well as face shield and donations of personal protective equipment. And overall, we believe that China could recover back to its pre-COVID-19 trajectory in Q3 and potentially be above plan in Q4. Importantly, we've seen a very recent slight improvement in April sales trends as some facilities to varying degrees have begun to reopen for elective procedures. And we have a very robust pipeline. Good morning, and thank you very much for all the information you've provided. Do the numbers hold clues to what lies ahead for the stock?

We just launched a new lead in pacemakers, which will help in that business. In venous, we received approval for the venous indication for WALLSTENT and anticipate approval for a new controller for the EKOS thrombectomy system and a new IVUS catheter. And maybe as a follow-up, maybe a little bit of a moot point here, but I just wanted to check, what were the trends like up through the middle of March in some of the businesses that faced a shortfall in fourth quarter? And also, we have moved to a four-day work week, and the goal for that would be for it to be a second-quarter impact only, but we'll see how that progresses as the recovery returns.
And since the government announced on March 18 that the country has passed the peak of the epidemic, we continue to see improvement each week in China. We'll go to the line of Robbie Marcus, JP Morgan. Sure. I would say the people are frustrated because they want to get out and see customers. And thereafter, our bonds mature at various times over the next 29 years and no year's bond debt maturities are expected to exceed more than 50% of available cash flow in any one year, with most significantly less than 50% of expected available cash flow. Please go ahead. How did those businesses trend before COVID really hit developed markets around the world? SpaceOAR is also an important technology for the recovery as treatments for cancer patients will be prioritized. In addition, we've made a decision, at least for the near term, to stop funding additional clinical or R&D work for Cytuity. We don't think it would be near to the same impact that we saw second half of March or April, but we continue to look at countermeasures we put in place in those cases. Thank you, Susie, and thank you to everyone for joining us today. And now the team did that, and we've learned a lot of new capabilities that will serve us well for years to come.

But our base-case assumption is really what we laid out here, which is the most significant decline in second quarter. Through the first three weeks of April, regional sales results have trended down 15% in Asia Pac, down 45% in Europe, Middle East, East Africa and down 55% in the U.S. versus prior year.

We framed our major product lines across the spectrum from emergent, which is measured in hours to days; to semi-emergent, which is measured in weeks; to elective, which is measured in months.

Good morning and thanks for taking the questions. I'd like to thank our employees for their winning spirit and commitment to emerge stronger in the recovery post-COVID. And LithoVue, which is our single-use urethroscope, could benefit as the current environment supports the speed and utility of single-use scopes. Jayson Bedford -- Raymond James -- Analyst. We have no plans to initiate a share repurchase or a dividend. Our Japanese business has been less impacted year to date but remains uncertain. CRM recovery will be led by HeartLogic, S-ICD replacements, as well as the ongoing U.S. launches of our INGEVITY+ Lead and 3,300 programmer with the remote service offerings.

This compares to earnings of $0.35 per share a year ago. In China, we estimate that the COVID-19 impact to procedures was close to $70 million in the first quarter. And I realize we haven't heard from the whole medical device universe in the first quarter, but it does seem like the actions that you're taking are, perhaps, a little more aggressive on the cost-cutting front than some of your peers. And so you'll continue to see us, we believe, having one of the most differentiated med tech portfolios in the business, a highly engaged workforce and the financial flexibility to weather the storm. Just a couple of product line questions. As a reminder, our largest source of liquidity is our $2.75 billion revolving credit facility, which matures in 2023. Yeah. As announced last week, we've successfully negotiated a $1.25 billion term loan and amendments to the maximum leverage covenants on our existing $1 billion term loan due 2021 and our revolver. And our final question will be from the line of Jayson Bedford of Raymond James. Yeah. They're highly engaged. Secondly, many of the actions that we've taken, actually, I think we led in this area, has been to secure our very important sales team, so we won't give the details there. I think we'll do everything we can to support our customers like we always do with clinical support, with excellent product supply and great innovation. Thank you and good morning. Contents: Prepared Remarks; Questions and Answers; Call Participants; Prepared … So to offset this, we continue to leverage our digital competencies to maintain connectivity with patients and physicians that were ready to serve them as procedures resume. Mike Mahoney -- Chairman and Chief Executive Officer. Good morning, David. Again, our expectation is for sequential improvement as revenue increases, resulting in more normalized margins by Q4. So I'd say -- and the sales piece of it -- and they also saw spec pharma do quite well. Thanks so much. And then one follow-up maybe on -- maybe pricing environment in a post-COVID world, maybe some general comments on -- as you see your customers being under pressure, does it change behavior? Thanks, Dan.

We also look forward to two virtual HRS late breakers in our CRM franchise, the PRAETORIAN and untouched trials, which should continue to support the global growth of our S-ICD franchise. Urology and pelvic health, given the high mix of deferrable procedures, trends through the first three weeks of April were down roughly 60% versus prior year, with sales from our Stone franchise and SpaceOAR products showing better resilience and more pressure in our prostate health, prosthetic urology and pelvic org franchises. The revolver in our term loans, which comprise approximately 25% of our outstanding debt are the only debt instruments subject to debt covenants. Kevin, please go ahead. A big part of the Boston Scientific story has always been the pipeline, and that's obviously hit a bump here as running trials is pretty difficult. Consistent with the deferral of elective procedures, we have witnessed a slowdown in ongoing clinical trial enrollments and thus would expect a delay to many of our clinical time lines of approximately six months. So I don't think that will be unique to Boston. This is probably the most detailed we've gotten from any company. Similarly, the ongoing launch of LOTUS Edge in the U.S. and Japan has been challenged by COVID-19 restrictions that limit proctor travel and the delivery of training, but we do look forward to the recovery in procedure volumes. But at this stage, I think it's probably premature to estimate whether it will be kind of a surge beyond that. Note: To add/edit Document item, please navigate through the Advanced Editing visible in the ribbon at the top. In addition, when estimating the overall pace of recovery, site of service is an important consideration, and the recent guidelines for reopening from a range of physician societies enable elective outpatient procedures to restart before inpatient procedures. And the integration of the commercial teams has really kind of taken place. All right. We're keeping the key R&D projects alive beyond this. When you combine this with an all-in gross margin that's likely to be below 70%, the net is that the month of April could actually see a negative operating margin. I want to get your thoughts on that and had a quick follow-up. And overall, the relatively low April sales decline in IC reflects that it's one of our highest mix franchises, both in terms of emergent and acute procedures. We're also partnering with our customers to enable a fast recovery while also acting to reduce operational expenses and preserving our cash position.

That's helpful. So we won't go through our eight scenarios we have for the remainder of the year, which I think is important to have for any company and actions we would take depending in those scenarios, either positive upside or potentially softening. I'm very proud of what we've seen. In interventional oncology, we plan to launch a new heat FX microwave ablation system and the true select microcatheter, so a very rich pipeline of launches in PI in 2020. Unfortunately, while we recognize the strong need for improved ovarian cancer detection options, particularly for women who have a high risk, our view of the clinical evidence necessary to establish practically utility of the product, as well as the current reimbursement landscape have extended the cost and time horizon to realize the commercial potential of Cytuity. They're rational cuts, and our employees support it. Before COVID, kind of pre mid-March, things were kind of going pretty nicely on the rails. And then maybe, Dan, can you just comment on the impact of selling the intrauterine health franchise? For the revolver, which extends through 2023, this max leverage ratio will continue to step down by 0.25 turn, 0.25 times, starting in Q1 2021, continuing each quarter thereafter until reaching 3.75 times in Q4 2021. Our next bond maturity is not until 2022 and is $500 million.