by ʇolɐǝz ǝɥʇ qoq

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I have had a look at enough medium format offerings, but all the products seems to offer many megapixels and poor performance at high ISOs.

Why doesn't a brand exist to offer slightly lower resolution (e.g. 25MP) and exploit the bigger sensor surface in order to have bigger pixels and a corresponding top-notch performance in low light / high ISO?

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This is rather obsolete now; both PhaseOne and Hasselblad make 50MP backs that are absolutely clean at ISO 6400, and Pentax (ever the rebel) will allow you to go much higher on their version (which uses the same Sony sensor chip) and live with the need to clean the image up a touch (ISO 25600 is very usable; ISOs 51200 and 102400 are very salvageable). – user28116 Aug 20 '14 at 11:58
up vote 5 down vote accepted

Larger formats exist mainly to increase the level of detail in the photographs produced. This was certainly true in the film era as film resolution was pretty much fixed (per unit area) but a larger negative could always produce more detailed prints. It is also largely true in the digital age as the highest megapixel sensors available are all larger than 35mm.

Shooting in low light leads to a lack of detail due to the noise that results from amplifying a weak signal. It therefore does not make sense to use a medium format digital camera for low light work as you wont get an appreciable gain in resolution. Thus medium format sensors are optimised for use at low ISO.

You wouldn't get many gains from the larger pixel size made possible for a larger sensor either, as medium format lenses are typically slower (smaller max aperture) in order to save weight (and again due to the use of medium format for detailed work, fast lenses produce less detail). f/2.8 is rare, f/2.0 lenses even more so.

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Basically - Medium format cameras are generally big, and designed primarily for studio environments, therefore designed to be used in a "controlled environment" where lighting can be set up with enough light for perfect exposure.

There is really no need for digital medium format cameras to have extreme high ISO performance. You don't see many night club photographers or 'Paps using Hasselblads do you!

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