By Thomas Lee

LITTLE CANADA, Minnesota – It’s no secret that pacemakers and defibrillators are no longer a hot growth market. Most estimates peg global sales at growing low to mid single digits for the foreseeable future.

But for St. Jude Medical Inc, (NYSE:STJ) the question remains: How much is the company to blame for its lackluster U.S. numbers?

The company said Tuesday 2009 sales grew 7 percent to $4.7 billion, from $4.4 billion a year ago. Seven percent is nothing to sneeze at, but take a closer look at its core cardiac rhythm management business: Fourth-quarter CRM sales actually fell one percent and annual sales grew three percent, mostly from international sales; U.S. sales were flat.

Last quarter, CEO Dan Starks sent his stock tumbling when he blamed a slowdown in hospital purchases on a weak economy and “uncertainties surrounding healthcare reform.”

In a conference call with investors Tuesday, Starks didn’t mention healthcare reform but reiterated his belief that hospitals are pulling back.

“We think that the customer, hospital management of capital, hospital management of inventory has tightened up during 2009,” Starks said. “We expect that management to continue, so we’re not expecting a rebound in inventory and our own internal modeling and our guidance anticipates that customers will continue to be very focused on managing inventory of CRM devices. … We think this is a phenomenon that is really here to stay longer-term.”

One problem with that explanation: Boston Scientific Corp. (NYSE:BSX) and Medtronic Inc. (NYSE:MDT) don’t see it that way.

“We have not seen the slowdown in hospital stocking described by St. Jude,” Boston Scientific CEO Ray Elliot said in October.

“In the U.S., we did not experience a slowdown in customer buying patterns,” Medtronic CEO Bill Hawkins told analysts last November.

So there are only two explanations for the discrepancy: either St. Jude misjudged customer demand or hospitals simply prefer the competition.

Starks suggested the former. In fact, he said, the hospital cutbacks create pent-up demand that will ultimately benefit St. Jude this year.

“The U.S. portion of our CRM business will get back on track to grow faster than the market in 2010,” Starks said.

Whether that happens or not depends on whom you believe: St. Jude or its two main competitors, who emphatically say they don’t see customer pullback.

So is CRM weakness an industry problem or a St. Jude problem?