Acutus Medical (AFIB) 10-K23 Mar 232022 FY Annual reportFinancial data

Company Profile

Cover Page

Cover Page - USD ($) $ in Millions	12 Months Ended
Cover Page - USD ($) $ in Millions	Dec. 31, 2022	Mar. 20, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-39430
Entity Registrant Name	ACUTUS MEDICAL, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	45-1306615
Entity Address, Address Line One	2210 Faraday Ave.
Entity Address, Address Line Two	Suite 100
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	442
Local Phone Number	232-6080
Title of 12(b) Security	Common stock, par value $0.001 per share
Trading Symbol	AFIB
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
ICFR Auditor Attestation Flag	false
Entity Shell Company	false
Entity Public Float			$ 31.8
Entity Common Stock, Shares Outstanding		28,894,080
Documents Incorporated by Reference	Part III of this Annual Report on Form 10-K incorporates certain information by reference from the definitive proxy statement for the Registrant’s 2023 Annual Meeting of Stockholders to be filed within 120 days of the Registrant’s fiscal year ended December 31, 2022 (the “Proxy Statement”). Except with respect to information specifically incorporated by reference in this Form 10-K, the Proxy Statement is not deemed to be filed as part of this Form 10-K.
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Central Index Key	0001522860

Audit Information

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2022
Audit Information [Abstract]
Auditor Name	KPMG LLP
Auditor Location	San Diego, California
Auditor Firm ID	185

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 25,584	$ 24,071
Marketable securities, short-term	44,863	76,702
Restricted cash	5,764	150
Accounts receivable	21,085	3,633
Inventory	13,327	16,408
Employer retention credit receivable	4,703	0
Prepaid expenses and other current assets	2,541	5,326
Total current assets	117,867	126,290
Marketable securities, long-term	0	7,120
Property and equipment, net	9,221	13,670
Right-of-use asset, net	3,872	4,521
Intangible assets, net	1,583	5,013
Goodwill	0	12,026
Other assets	897	1,152
Total assets	133,440	169,792
Current liabilities:
Accounts payable	4,721	7,519
Accrued liabilities	9,686	9,096
Contingent consideration, short-term	1,800	1,500
Operating lease liabilities, short-term	319	395
Warrant liability	3,346	0
Total current liabilities	19,872	18,510
Operating lease liabilities, long-term	4,103	4,591
Long-term debt	34,434	40,415
Contingent consideration, long-term	0	500
Other long-term liabilities	12	50
Total liabilities	58,421	64,066
Commitments and contingencies (Note 13)
Stockholders' equity
Preferred stock: Series A Common Equivalent Preferred Stock, 0.001 par value; 5,000,000 shares authorized, and 6,666 shares issued and outstanding	0	0
Common stock: 0.001 par value; 260,000,000 shares authorized, 28,554,656 and 27,957,223 issued and outstanding at December 31, 2022 and 2021, respectively	29	28
Additional paid-in capital	594,173	584,613
Accumulated deficit	(518,314)	(478,698)
Accumulated other comprehensive loss	(869)	(217)
Total stockholders' equity	75,019	105,726
Total liabilities and stockholders' equity	$ 133,440	$ 169,792

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	6,666	6,666
Preferred stock, shares outstanding (in shares)	6,666	6,666
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	260,000,000	260,000,000
Common stock, shares issued (in shares)	28,554,656	27,957,223
Common stock, shares outstanding (in shares)	28,554,656	27,957,223

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Revenue	$ 16,363,000	$ 17,263,000
Costs and operating expenses (income):
Cost of products sold	31,910,000	32,925,000
Research and development	28,153,000	36,683,000
Selling, general and administrative	47,654,000	63,523,000
Goodwill impairment	12,026,000	0
Restructuring	2,371,000	0
Change in fair value of contingent consideration	1,053,000	(3,746,000)
Gain on sale of business	(79,465,000)	0
Total costs and operating expenses	43,702,000	129,385,000
Loss from operations	(27,339,000)	(112,122,000)
Other income (expense):
Loss on debt extinguishment	7,947,000	0
Change in fair value of warrant liability	33,000	0
Interest income	868,000	116,000
Interest expense	(5,149,000)	(5,677,000)
Total other expense, net	(12,195,000)	(5,561,000)
Loss before income taxes	(39,534,000)	(117,683,000)
Income tax expense	82,000	0
Net loss	(39,616,000)	(117,683,000)
Other comprehensive income (loss):
Unrealized gain (loss) on marketable securities	39,000	(37,000)
Foreign currency translation adjustment	(691,000)	(460,000)
Comprehensive loss	$ (40,268,000)	$ (118,180,000)
Net loss per common share, basic (in dollars per share)	$ (1.40)	$ (4.11)
Net loss per common share, diluted (in dollars per share)	$ (1.40)	$ (4.11)
Weighted average shares outstanding, basic (in shares)	28,322,753	28,654,313
Weighted average shares outstanding, diluted (in shares)	28,322,753	28,654,313

Consolidated Statements of Stoc

Consolidated Statements of Stockholders’ Equity - USD ($) $ in Thousands	Total	Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Balance at beginning of period, preferred stock (in shares) at Dec. 31, 2020		0
Balance at beginning of period at Dec. 31, 2020	$ 126,583	$ 0	$ 28	$ 487,290	$ (361,015)	$ 280
Balance at beginning of period, common stock (in shares) at Dec. 31, 2020			27,991,425
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized gain (loss) on marketable securities	(37)					(37)
Foreign currency translation adjustment	(460)					(460)
Issuance of common stock for cash, net of issuance costs of $5,893 (in shares)			6,325,000
Issuance of common stock for cash, net of issuance costs of $5,893	$ 82,657		$ 6	82,651
Stock option exercises (in shares)	111,804		111,804
Stock option exercises	$ 711			711
Stock-based compensation (in shares)			134,236
Stock-based compensation	13,515			13,515
Employee stock purchase plan shares issued (in shares)			33,641
Employee stock purchase plan shares issued	440			440
Issuance of common stock for cashless warrant exercise (in shares)			26,958
Issuance of common stock for cashless warrant exercise	0
Exchange of common stock for Series A Common Equivalent Preferred Stock (in shares)		6,666	(6,665,841)
Stock Issued During Period, Value, Conversion of Convertible Securities	0		$ (6)	6
Net loss	$ (117,683)				(117,683)
Balance at end of period, preferred stock (in shares) at Dec. 31, 2021	6,666	6,666
Balance at end of period at Dec. 31, 2021	$ 105,726	$ 0	$ 28	584,613	(478,698)	(217)
Balance at end of period, common stock (in shares) at Dec. 31, 2021	27,957,223		27,957,223
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized gain (loss) on marketable securities	$ 39					39
Foreign currency translation adjustment	$ (691)					(691)
Stock option exercises (in shares)	35,478		35,478
Stock option exercises	$ 67		$ 1	66
Stock-based compensation (in shares)			412,628
Stock-based compensation	9,280			9,280
Employee stock purchase plan shares issued (in shares)			149,327
Employee stock purchase plan shares issued	214			214
Net loss	$ (39,616)				(39,616)
Balance at end of period, preferred stock (in shares) at Dec. 31, 2022	6,666	6,666
Balance at end of period at Dec. 31, 2022	$ 75,019	$ 0	$ 29	$ 594,173	$ (518,314)	$ (869)
Balance at end of period, common stock (in shares) at Dec. 31, 2022	28,554,656		28,554,656

Consolidated Statements of Conv

Consolidated Statements of Convertible Preferred Stock and Stockholders’ Equity (Parenthetical) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Statement of Stockholders' Equity [Abstract]
Issuance costs	$ 5,893

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
Consolidated Statements of Cash Flows - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities
Net loss	$ (39,616,000)	$ (117,683,000)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation expense	6,060,000	5,754,000
AcQMap Systems converted to sales	605,000	2,182,000
Sales-type lease loss (gain)	(87,000)	28,000
Amortization of intangible assets	420,000	640,000
Non-cash stock-based compensation expense	9,391,000	13,754,000
Amortization of premiums (accretion of discounts) on marketable securities, net	(24,000)	1,277,000
Amortization of debt issuance cost	850,000	1,404,000
Amortization of operating lease right-of-use assets	649,000	496,000
Goodwill impairment	12,026,000	0
Loss on extinguishment of debt	7,947,000	0
Gain on sale of business, net	79,465,000	0
Direct costs paid for sale of business	(4,027,000)	0
Change in fair value of warrant liability	(33,000)	0
Loss on disposal of fixed assets	825,000	0
Change in fair value of contingent consideration	1,053,000	(3,746,000)
Changes in operating assets and liabilities:
Accounts receivable	(452,000)	(1,473,000)
Inventory	3,081,000	(3,872,000)
Employer retention credit receivable	(4,703,000)	0
Prepaid expenses and other current assets	2,804,000	1,133,000
Other assets	475,000	304,000
Accounts payable	(2,852,000)	(871,000)
Accrued liabilities	605,000	1,549,000
Operating lease liabilities	(526,000)	(608,000)
Other long-term liabilities	(38,000)	50,000
Net cash used in operating activities	(85,032,000)	(99,682,000)
Cash flows from investing activities
Proceeds from sale of business	70,000,000	0
Purchases of available-for-sale marketable securities	(54,508,000)	(87,258,000)
Sales of available-for-sale marketable securities	18,599,000	8,590,000
Maturities of available-for-sale marketable securities	74,642,000	107,707,000
Purchases of fixed assets	(3,983,000)	(9,973,000)
Net cash provided by investing activities	104,750,000	19,066,000
Cash flows from financing activities
Proceeds from issuance of common stock, net of issuance costs	0	82,657,000
Proceeds from the exercise of stock options	67,000	711,000
Repurchase of common shares to pay employee withholding taxes	(111,000)	0
Proceeds from employee stock purchase plan	214,000	440,000
Payment of contingent consideration	(872,000)	(3,435,000)
Payment of deferred offering costs	0	(580,000)
Payment of contingent consideration into escrow	0	(224,000)
Repayment of old term loan	(44,550,000)	0
Prepayment penalty fees	(1,063,000)	0
Borrowing under new term loan	34,825,000	0
Payment of debt issuance costs for new loan	(626,000)	0
Net cash (used in) provided by financing activities	(12,116,000)	79,569,000
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(475,000)	(116,000)
Net change in cash, cash equivalents and restricted cash	7,127,000	(1,163,000)
Cash, cash equivalents and restricted cash at the beginning of the period	24,221,000	25,384,000
Cash, cash equivalents and restricted cash at the end of the period	31,348,000	24,221,000
Supplemental disclosure of cash flow information:
Cash paid for interest	4,231,000	4,259,000
Supplemental disclosure of noncash investing and financing activities:
Amount of debt proceeds allocated to warrant liability	3,379,000	0
Accounts receivable from sale of business	17,000,000	0
Change in unrealized loss on marketable securities	(39,000)	37,000
Right-of-use assets exchanged for operating lease liabilities	0	3,527,000
Contingent consideration escrow release	381,000	119,000
Change in unpaid purchases of property and equipment	54,000	124,000
Net book value on AcQMap system sales-type leases	$ 244,000	$ 1,104,000

Organization and Description of

Organization and Description of Business	12 Months Ended
Organization and Description of Business	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Description of Business	Organization and Description of Business Acutus Medical, Inc. (the “Company”) is an arrhythmia management company focused on improving the way cardiac arrhythmias are diagnosed and treated. The Company designs, manufactures and markets a range of tools for catheter-based ablation procedures to treat various arrhythmias. The Company’s product portfolio includes novel access sheaths, diagnostic and mapping catheters, ablation catheters, mapping and imaging consoles and accessories, as well as supporting algorithms and software programs. The Company was incorporated in the state of Delaware on March 25, 2011, and is located in Carlsbad, California. Liquidity and Capital Resources The Company has limited revenue and has incurred significant operating losses and negative cash flows from operations since its inception, and anticipates that it will incur significant losses for at least the next several years. As of December 31, 2022 and 2021, the Company had cash, cash equivalents and marketable securities of $70.4 million and $107.9 million, respectively. For the years ended December 31, 2022 and 2021, net losses were $39.6 million and $117.7 million, respectively, and net cash used in operating activities was $85.0 million and $99.7 million respectively. As of December 31, 2022 and 2021, the Company had an accumulated deficit of $518.3 million and $478.7 million, respectively, and working capital of $98.0 million and $107.8 million, respectively. Since raising $166.3 million from its IPO in August 2020, the Company has issued additional shares of common stock. From time to time, the Company's Board of Directors issues common stock for its stock-based compensation plans and for its ESPP. Additionally, in July 2021, the Company issued 6,325,000 shares of common stock in a public offering, which included 825,000 shares of common stock issued upon the underwriter’s exercise in full of an option to purchase additional shares of common stock. The price to the public for each share was $14.00. The Company received gross proceeds of $88.6 million from the offering. Net of underwriting discounts and commission and other offering expenses, the Company received proceeds of $82.7 million. On June 30, 2022, Medtronic, Inc. ("Medtronic") paid the Company $50.0 million at the First Closing of the sale of its left-heart access portfolio to Medtronic, of which $4.0 million was paid into an indemnity escrow account for a period of 18 months following the First Closing to secure the Company's indemnification obligations under the Asset Purchase Agreement. The OEM Earnout under the Asset Purchase Agreement with Medtronic was achieved on October 31, 2022, with $20.0 million paid in November 2022. Additionally, the Transfer Earnout under the Asset Purchase Agreement with Medtronic was achieved on December 21, 2022. Accordingly, cash consideration of $17.0 million payable to the Company for the satisfaction of the Transfer Earnout conditions was received from Medtronic on January 13, 2023. Management believes the Company's current cash, cash equivalents and marketable securities are sufficient to fund operations for at least the next 12 months from the date of this filing. To ensure that the Company has sufficient resources to fund operations, management continues to review cost improvement opportunities and pathways to reduce expenses and cash burn, while preserving the resources to invest in future growth.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
Summary of Significant Accounting Policies	Dec. 31, 2022
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). Principles of Consolidation The consolidated financial statements include the accounts of Acutus Medical, Inc. and its wholly-owned subsidiary Acutus Medical NV (“Acutus NV”), which was incorporated under the laws of Belgium in August 2013. All intercompany balances and transactions have been eliminated in consolidation. Use of Estimates and Assumptions The preparation of the consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, expenses and disclosures of contingent assets and liabilities. These estimates and assumptions are based on current facts, historical experience and various other factors believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities and the recording of revenue and expenses that are not readily apparent from other sources. Actual results could differ from those estimates. Segments Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker in making decisions regarding resource allocation and assessing performance. The Company views its operations and manages its business in one operating and reportable segment. Cash and Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with maturities of three months or less when purchased to be cash equivalents. All of the Company’s cash equivalents have liquid markets and high credit ratings. The Company maintains its cash in bank deposits and other accounts, the balances of which, at times and as of December 31, 2022 and 2021, exceeded federally insured limits. Restricted cash consists of (i) deposited cash collateral for the Company’s corporate credit card program and (ii) cash received for the sale of business to Medtronic held in an indemnity escrow account until certain terms of sale are met. The following table reconciles cash and restricted cash in the consolidated balance sheets to the totals shown on the consolidated statements of cash flows (in thousands). December 31, 2022 December 31, 2021 Cash and cash equivalents $ 25,584 $ 24,071 Restricted cash 5,764 150 Total cash, cash equivalents and restricted cash $ 31,348 $ 24,221 Marketable Securities The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities and Yankee debt securities. The Company considers its debt securities to be available-for-sale securities. Available-for-sale securities are initially classified as cash equivalents, short-term marketable securities or long-term marketable securities based on the maturity date at time of purchase and their availability to meet current operating requirements. Marketable securities that mature in three months or less from the date of purchase are classified as cash equivalents. Marketable securities excluding cash equivalents that mature in one year or less are classified as short-term available-for-sale securities and are reported as a component of current assets. Securities that are classified as available-for-sale are measured at fair value with temporary unrealized gains and losses reported in other comprehensive loss and as a component of stockholders’ equity until their disposition or maturity. The Company reviews all available-for-sale securities at each period end to determine if they remain available-for-sale based on the Company’s current intent and ability to sell the security if it is required to do so. Realized gains and losses from the sale of marketable securities, if any, are calculated using the specific-identification method. Marketable securities are subject to a periodic impairment review. The Company may recognize an impairment charge when a decline in the fair value of investments below the cost basis is determined to be other-than-temporary. In determining whether a decline in market value is other-than-temporary, various factors are considered including the cause, duration of time and severity of the impairment, any adverse changes in the investees’ financial condition and the Company’s intent and ability to hold the security for a period of time sufficient to allow for an anticipated recovery in market value. Declines in value judged to be other-than-temporary are included in the Company’s consolidated statements of operations and comprehensive loss. The Company recorded no other-than-temporary impairments related to marketable securities in the Company’s consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 and 2021. Concentrations of Credit Risk and Off-Balance Sheet Risk Financial instruments that potentially subject the Company to credit risk consist principally of cash, cash equivalents, restricted cash, accounts receivable and marketable securities. Cash and restricted cash are maintained in accounts with financial institutions, which, at times may exceed the Federal depository insurance coverage of $0.25 million. The Company has not experienced losses on these accounts and management believes, based upon the quality of the financial institutions, that the credit risk with regard to these deposits is not significant. Revenue from Contracts with Customers The Company accounts for revenue earned from contracts with customers under ASC 606, Revenue from Contracts with Customers (“ASC 606”), and ASC 842, Leases (“ASC 842”). The core principle of ASC 606 is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The following five steps are applied to achieve that core principle: • Step 1: Identify the contract with the customer. • Step 2: Identify the performance obligations in the contract. • Step 3: Determine the transaction price. • Step 4: Allocate the transaction price to the performance obligations in the contract. • Step 5: Recognize revenue when, or as, the company satisfies a performance obligation. ASC 842 provides guidance on determining whether an agreement contains a lease. ASC 842 defines a lease as a contract, or part of a contract, that conveys the right to control the use of identified property, plant or equipment for a period of time in exchange for consideration. For new customers, the Company places its medical diagnostic equipment, the AcQMap System, at customer sites under evaluation agreements, and generates revenue from the sale of disposable products used with the AcQMap System. Disposable products primarily include AcQMap Catheters and AcQGuide Steerable Sheaths. Outside of the U.S., the Company also has the Qubic Force Device which generates revenue from the sale of the AcQBlate FORCE Ablation Catheters. The Company provides the disposable products in exchange for consideration, which occurs when a customer submits a purchase order and the Company provides disposables at the agreed upon prices in the invoice. Generally, the AcQMap System is provided to the customer for free with no binding agreement or requirement to purchase any disposable products, and customers thereafter purchase disposable products using separate purchase orders. The Company has elected the practical expedient and accounting policy election to account for the shipping and handling as activities to fulfill the promise to transfer the disposable products and not as a separate performance obligation. Additionally, the Company sells the AcQMap System to customers along with software updates on a when-and-if-available basis, as well as the Qubic Force Device and a transseptal crossing line of products which can be used in a variety of heart procedures and does not need to be accompanied with an AcQMap System or Qubic Force Device. Included in the transseptal crossing line of products are primarily the AcQRef introducer sheath, the AcQGuide sheaths and the AcQCross Transseptal Dilator/Needle. The Company also enters into deferred equipment agreements that are generally structured such that the Company agrees to provide an AcQMap System at no up-front charge, with title of the device transferring to the customer at the end of the contract term in exchange for the customer’s commitment to purchase disposables at a specified price over the term of the agreement, which generally ranges from two Lastly, the Company enters into short-term operating leases for the rental of the AcQMap System after an evaluation. These lease agreements impose no requirement on the customer to purchase the equipment, and the equipment is not transferred to the customer at the end of the lease term. The short-term nature of the lease agreements does not result in lease payments accumulating to an amount that equals the value of the equipment nor is the lease term reflective of the economic life of the equipment. The Company’s contracts primarily include fixed consideration. Generally, there are no discounts, rebates, returns or other forms of variable consideration. Customers are generally required to pay within 30 to 60 days. The delivery of disposable products are performance obligations satisfied at a point in time. The disposable products are shipped free on board (“FOB”) shipping point or FOB destination. For disposable products that are shipped FOB shipping point, the customer has the significant risks and rewards of ownership and legal title to the assets when the disposable products leave the Company’s shipping facilities, thus the customer obtains control and revenue is recognized at that point in time. Revenue is recognized on delivery for disposable products shipped via FOB destination. For direct customers, the installation and delivery of the AcQMap System is satisfied at a point in time when the installation is complete, which is when the customer can benefit and has control of the system. For AcQMap System sales sold to Biotronik, the installation is not a performance obligation as it is performed by Biotronik, and therefore, the AcQMap System is satisfied at a point in time when they have control of the system. The Company’s software updates and equipment service performance obligations are satisfied evenly over time as the customer simultaneously receives and consumes the benefits of the Company’s performance for these services throughout the service period. The Company allocates the transaction price to each performance obligation identified in the contract based on the relative standalone selling price (“SSP”). The Company determines SSP for the purposes of allocating the transaction price to each performance obligation based on the adjusted market assessment approach that maximizes the use of observable inputs, which include, but are not limited to, sales transactions where the specific performance obligations are sold separately, company list prices and specific offers to customers. Except for the deferred equipment agreements noted above, the Company’s contracts with customers generally have an expected duration of one year or less, and therefore, the Company has elected the practical expedient in ASC 606 to not disclose information about its remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative (“SG&A”) expense as incurred due to the short duration of the Company’s contracts. The Company’s contract balances consisted solely of accounts receivable as of December 31, 2022 and 2021. In May 2020, the Company entered into Bi-Lateral Distribution Agreements with Biotronik. Pursuant to the Bi-Lateral Distribution Agreements, the Company obtained a non-exclusive license to distribute a range of Biotronik’s products and accessories in the United States, Canada, China, Hong Kong and multiple Western European countries under the Company’s private label. Moreover, if an investigational device exemption ("IDE") clinical trial is required for these products to obtain regulatory approval in the United States, or a clinical trial is required for these products to obtain regulatory approval in China, the Company will obtain an exclusive distribution right in such territories for a term of up to five years commencing on the date of regulatory approval if the Company covers the cost of the IDE or other clinical trial and the Company conducts such study within a specified period. Biotronik also agreed to distribute the Company’s products and accessories in Germany, Japan, Mexico, Switzerland and multiple countries in Asia-Pacific, Eastern Europe, the Middle East and South America. The Company also granted Biotronik a co-exclusive right to distribute these products in Hong Kong. Each party will pay a specified transfer price on the sale of the other party’s products and, accordingly, will earn a distribution margin on the sale of the other party’s products. In 2022, the Company sold the left-heart access transseptal crossing business to Medtronic. Under a Distribution Agreement, the Company will act as the OEM supplier of these products. The Company will produce and sell the products to Medtronic for a period of up to four years. Revenue is recognized when the title to the products are transferred to Medtronic, which occurs when the products are shipped from our facility (FOB shipping point). The following table sets forth the Company’s revenue for disposables, systems, and service/other for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Disposables $ 12,922 $ 11,938 Systems 1,750 4,058 Service/Other 1,691 1,267 Total revenue $ 16,363 $ 17,263 The following table provides revenue by geographic location for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 United States $ 8,707 $ 8,325 Outside the United States 7,656 8,938 Total revenue $ 16,363 $ 17,263 Inventory Inventory is stated at the lower of cost (first-in, first-out basis) or net realizable value. The Company recorded write-downs for excess and obsolete inventory of $3.8 million and $1.3 million for the years ended December 31, 2022 and 2021, respectively, based on management’s review of inventories on hand, comparisons to estimated future usage and sales, observed shelf-life and assumptions about the likelihood of obsolescence. Accounts Receivable Trade accounts receivable are recorded net of allowances for uncollectible accounts. The Company evaluates the collectability of its accounts receivable based on various factors including historical experience, the length of time the receivables are past due and the financial health of the customer. The Company reserves specific receivables if collectability is no longer reasonably assured. Based upon the assessment of these factors, the Company did not record an allowance for uncollectible accounts as of December 31, 2022 or 2021. Pursuant to the Asset Purchase Agreement with Medtronic (see Note 4 - Sale of Business) , the Company is eligible to receive contingent cash consideration of $17.0 million (the "Transfer Earnout") upon the Company’s initial submission for CE Mark certification. The Company met this condition as of December 31, 2022 and recorded a receivable on the consolidated balance sheets for the year then ended. Medtronic provided full payment in January 2023. Accounts receivable recorded on the consolidated balance sheets for the years ended December 31, 2022 and 2021 consists of the following (in thousands): December 31, 2022 December 31, 2021 Trade accounts receivable $ 4,085 $ 3,633 Transfer earnout receivable 17,000 — Total accounts receivable $ 21,085 $ 3,633 Employee Retention Credit Receivable The Employee Retention Credit is a refundable U.S. tax credit separate from tax based on income for businesses that continued to pay employees while shut down due to the COVID-19 pandemic or had significant declines in gross receipts from March 13, 2020 to December 31, 2021. The Company is an eligible employer qualifying under the program, applied for the tax credit in 2022 and is expecting receipt in the early part of 2023. Property and Equipment, Net Property and equipment is recorded at cost. Depreciation and amortization are provided using the straight-line method over the estimated useful lives of the related assets, generally three Intangible Assets Intangible assets consist of acquired developed technology and customer-related intangible assets acquired as part of the acquisition of Rhythm Xience. The Company’s intangible assets also include a license agreement with Biotronik. The Company determines the appropriate useful life of its finite-lived intangible assets by performing an analysis of expected cash flows of the acquired assets. Finite-lived intangible assets are amortized over their estimated useful lives using the straight-line method, which approximates the pattern in which the economic benefits are consumed. Acquired in-process technology is classified as a finite-lived intangible and amortized accordingly. Indefinite-lived intangible assets are tested for impairment at least annually and are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Indefinite-lived intangible assets are impaired if their estimated fair values are less than their carrying value. During the year ended December 31, 2022, the Company disposed of intangible assets related to the sale of the left-heart access business to Medtronic. These intangible assets consisted of its developed technology and its customer-related intangible assets. See Note 4 - Sale of Business and Note 9 - Goodwill and Intangible Assets for additional details. Goodwill Goodwill represents the excess of the purchase price of an entity over the estimated fair value of the assets acquired and liabilities assumed. Under ASC 350, Intangibles – Goodwill and Other (“ASC 350”), goodwill is not amortized but is subject to periodic impairment testing. ASC 350 requires that an entity assign its goodwill to reporting units and test each reporting unit’s goodwill for impairment at least on an annual basis and between annual tests if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying amount. In the evaluation of goodwill for impairment, which is performed annually during the fourth quarter, the Company first assesses qualitative factors to determine whether the existence of events or circumstances led to a determination that it was more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events or circumstances, it is determined that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company is required to perform a quantitative goodwill impairment test. The Company could also elect to perform a quantitative impairment test without first assessing qualitative factors. For the year ended December 31, 2021, the quantitative testing indicated no impairment for the carrying amount of goodwill. For the year ended December 31, 2022, the Company identified a triggering event prior to its annual assessment and determined a quantitative goodwill impairment test was required. The test indicated the fair value of goodwill recorded on the Company's consolidated balance was zero. Consequently, the Company fully impaired the carrying amount of $12.0 million and recorded a corresponding charge on the consolidated statements of operations and comprehensive loss. Refer to Note 9 - Goodwill and Intangible Assets for additional details. Impairment of Long-Lived Assets The Company reviews long-lived assets, including property and equipment and finite-lived intangible assets, for impairment whenever events or changes in business circumstances indicate that the carrying amount of the assets may not be fully recoverable. An impairment loss is recognized when the asset’s carrying value exceeds the total undiscounted cash flows expected from its use and eventual disposition. The amount of the impairment loss is determined as the excess of the carrying value of the asset over its fair value. For the years ended December 31, 2022 and 2021, the Company determined that there was no impairment of property and equipment or intangible assets other than goodwill. Foreign Currency Translation and Transactions The assets, liabilities and results of operations of Acutus NV are recorded using the Euro as the designated functional currency, which is the currency of the primary economic environment in which Acutus NV operates. Consequently, transactions in currencies other than Euro are measured and recorded in Euro. Upon consolidation with the Company, its assets and liabilities are translated to U.S. dollars at currency exchange rates as of the balance sheet date and its revenues and expenses are translated at the weighted-average currency exchange rates during the applicable reporting periods. Translation adjustments resulting from the process of translating this entity’s financial statements are reported in accumulated other comprehensive income (loss) in the consolidated balance sheets and foreign currency translation adjustment in the consolidated statements of operations and comprehensive loss. Lease Property The Company leases office space in Carlsbad, CA as its corporate headquarters and for manufacturing operations. Additionally, it leases office space in Zaventem, Belgium for international operations. The Company accounts for its lease property under ASC 842. Under this guidance, arrangements meeting the definition of a lease are classified as operating or financing leases, and are recorded on the consolidated balance sheet as both a right-of-use asset and a lease liability, calculated by discounting fixed lease payments over the lease term at the rate implicit in the lease or the Company’s incremental borrowing rate, which is the rate for collateralized borrowings based on the current economic environment, credit history, credit rating, value of leases, currency in which the lease obligation is satisfied, rate sensitivity, lease term and materiality . Lease liabilities are increased by interest and reduced by payments each period, and the right-of-use asset is amortized over the lease term. For operating leases, interest on the lease liability and the amortization of the right-of-use asset results in straight-line rent expense over the lease term. Variable lease expenses are recorded when incurred. In calculating the right-of-use asset and lease liability, the Company elected to combine lease and non-lease components. The Company adopted the policy election to exclude short-term leases having initial terms of twelve months from the initial recognition provisions of ASC 842. See Note 12 - Operating leases for additional details. Cost of Products Sold Cost of products sold includes raw materials, direct labor, manufacturing overhead, shipping and receiving costs and other less significant indirect costs related to the production of the Company’s products. Research and Development The Company is actively engaged in new product research and development efforts. Research and development expenses consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel directly engaged in research and development activities, clinical trial expenses, equipment costs, material costs, allocated rent and facilities costs and depreciation. Research and development expenses relating to possible future products are expensed as incurred. The Company also accrues and expenses costs for activities associated with clinical trials performed by third parties as incurred. All other costs relative to setting up clinical trial sites are expensed as incurred. Clinical trial site costs related to patient enrollment are accrued as patients are entered into the trials. Selling, General and Administrative SG&A consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel in sales, executive, finance and other administrative functions, allocated rent and facilities costs, legal fees relating to intellectual property and corporate matters, professional fees for accounting and consulting services, marketing costs and insurance costs. The Company expenses all SG&A costs as incurred. Fair Value Measurements Financial Instruments Fair value measurements are based on the premise that fair value is an exit price representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the following three-tier fair value hierarchy is used in determining the inputs for measuring fair value: Level 1—Quoted prices in active markets for identical assets or liabilities. Level 2—Observable inputs other than Level 1 prices for similar assets or liabilities that are directly or indirectly observable in the marketplace. Level 3—Unobservable inputs which are supported by little or no market activity and consist of financial instruments valued using pricing models, discounted cash flow methodologies or similar techniques, as well as instruments for which the determination of fair value requires significant judgment or estimation. Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Management’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed or initial amounts recorded may not be indicative of the amount that the Company or holders of the instruments could realize in a current market exchange. There were no transfers made among the three levels in the fair value hierarchy for the years ended December 31, 2022 and 2021. As of December 31, 2022 and 2021, the Company’s cash (excluding cash equivalents which are recorded at fair value on a recurring basis), restricted cash, accounts receivable, accounts payable and accrued expenses were carried at cost, which approximates the fair values due to the short-term nature of each instrument. The carrying amount of the Company’s long-term debt approximates fair value due to its variable market interest rate and management’s opinion that current rates and terms that would be available to the Company with the same maturity and security structure would be essentially equivalent to that of the Company’s long-term debt. The following tables classify the Company’s financial assets and liabilities measured at fair value on a recurring basis into the fair value hierarchy as of December 31, 2022 and 2021 (in thousands): As of December 31, 2022 Quoted Significant Significant Total Assets included in: Cash and cash equivalents Money market securities $ 22,700 $ — $ — $ 22,700 Marketable securities at fair value U.S. treasury securities — 26,897 — 26,897 Commercial paper — 14,764 — 14,764 Yankee debt securities — 3,202 — 3,202 Total fair value $ 22,700 $ 44,863 $ — $ 67,563 Liabilities included in: Warrant liability $ — $ — $ 3,346 $ 3,346 Contingent consideration — — 1,800 1,800 Total fair value $ — $ — $ 5,146 $ 5,146 As of December 31, 2021 Quoted Significant Significant Total Assets included in: Cash and cash equivalents Money market securities $ 21,893 $ — $ — $ 21,893 Marketable securities at fair value Corporate debt securities — 18,860 — 18,860 U.S. treasury securities — 5,064 — 5,064 Commercial paper — 36,759 — 36,759 Yankee debt securities — 3,932 — 3,932 Supranational — 3,051 — 3,051 Asset-backed securities — 16,156 — 16,156 Total fair value $ 21,893 $ 83,822 $ — $ 105,715 Liabilities included in: Contingent consideration $ — $ — $ 2,000 $ 2,000 Total fair value $ — $ — $ 2,000 $ 2,000 The fair value of the Company’s money market funds is determined using quoted market prices in active markets for identical assets. The fair value for the available-for-sale marketable securities is determined based on valuation models using inputs that are observable either directly or indirectly (Level 2 inputs) such as quoted prices for similar assets, yield curve, volatility factors, credit spreads, default rates, loss severity, current market and contractual prices for the underlying instruments, broker and dealer quotes, as well as other relevant economic measures. Financial Obligations The following table presents changes in Level 3 liabilities measured at fair value for the years ended December 31, 2022 and 2021 (in thousands): Contingent Warrant Liability Balance, December 31, 2020 $ 9,300 Payment of contingent consideration (3,435) Escrow release (1) (119) Change in fair value (3,746) Balance, December 31, 2021 $ 2,000 $ — Payment of contingent consideration (872) — Escrow release (1) (381) — Issuance of common stock warrants (2) — 3,313 Change in fair value 1,053 33 Balance, December 31, 2022 $ 1,800 $ 3,346 ____________________ (1) As part of the Rhythm Xience acquisition (see Note 3 - Asset Acquisition and Business Combination) , the first $0.5 million earned related to revenue success payments was paid at the end of the first month following the end of the quarter in which the revenue success payments were earned, into an escrow account until the expiration of an additional 18 month hold-back period commencing with the end of the quarter during which such revenue success payment amounts were earned. Amounts noted above were released from the escrow account. (2) Common stock warrants issued to lenders under the 2022 Credit Agreement (see Note 11 - Debt and Note 14 - Warrants ). Unrealized gains and losses associated with liabilities within the Level 3 category include changes in fair value that were attributable to both observable (e.g., changes in market interest rates) and unobservable (e.g., changes in unobservable long-dated volatilities) inputs. Contingent Consideration The fair value of the contingent consideration from the acquisition of Rhythm Xience represents the estimated fair value of future payments due to the sellers of Rhythm Xience based on the achievement of certain milestones and revenue-based targets in certain years. The initial fair value of the revenue-based contingent consideration was calculated through the use of a Monte Carlo simulation using revenue projections for the respective earn-out period, corresponding targets and approximate timing of payments as outlined in the purchase agreement. The analyses used the following assumptions: (i) expected term; (ii) risk-adjusted net sales; (iii) risk-free interest rate; and (iv) expected volatility of net sales (see table below). Estimated payments as determined through the respective model were further discounted by a credit spread assumption to account for credit risk. The fair value of the milestones-based contingent consideration was determined by probability weighting and discounting to the respective valuation date at the Company’s cost of debt. The Company’s cost of debt was determined by performing a synthetic credit rating for the Company and selecting yields based on companies with a similar credit rating. The contingent consideration is revalued to fair value each period on the consolidated balance sheets, and any increase or decrease is recorded on the consolidated statements of operations and comprehensive loss. The fair value of the contingent consideration may be impacted by certain unobservable inputs, most significantly with regard to discount rates, expected volatility and historical and projected performance. Significant changes to these inputs in isolation could result in a significantly different fair value measurement. The weighted-average (in

Asset Acquisition and Business

Asset Acquisition and Business Combination	12 Months Ended
Asset Acquisition and Business Combination	Dec. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Asset Acquisition and Business Combination	Asset Acquisition and Business Combination Biotronik Asset Acquisition In July 2019, the Company entered into a License and Distribution Agreement with Biotronik and VascoMed GmbH (collectively, the “Biotronik Parties”) whereby the Company acquired certain manufacturing equipment and obtained a license under certain patents and technology to develop, commercialize, distribute and manufacture the AcQBlate FORCE ablation catheters and Qubic Force Device. In accordance with ASC 805, the Biotronik Asset Acquisition was accounted for as an asset acquisition, as substantially all of the $15.0 million value transferred to Biotronik was allocated to intellectual property and charged to research and development expense - license acquired in the consolidated statements of operations and comprehensive loss. The agreement provides for additional milestone payments of up to $10.0 million contingent upon certain regulatory approvals and first commercial sale, of which $2.0 million has been paid as of December 31, 2022. upon regulatory approval of the Company’s force sensing ablation catheter in Europe. The Company determined that payment of the remaining $8.0 million of contingent milestones is not probable and estimable, and therefore the potential liability is not recorded as of December 31, 2022 and December 31, 2021. In further consideration of the rights granted, beginning with the Company’s first commercial sale of the first force sensing ablation catheter within the licensed product line, the agreement specifies per-unit royalty payments to the Biotronik Parties. As sales of catheters are recognized, royalties are recorded as cost of products sold on the statements of operations and comprehensive loss. As of December 31, 2022, less than $0.1 million has been included within accrued liabilities for these royalties. Rhythm Xience Business Combination On June 18, 2019, the Company acquired an integrated family of transseptal crossing and steerable introducer systems through its acquisition of Rhythm Xience for $3.0 million in cash in exchange for all of the stock of Rhythm Xience (the “Rhythm Xience Acquisition”). The purchase agreement included a potential of $17.0 million in earn-out consideration to be paid based on the achievement of certain regulatory milestones and revenue milestones, of which $7.2 million has been paid as of December 31, 2022. In accordance with ASC 805, the Rhythm Xience Acquisition was accounted for as a business combination. Additionally as part of the Rhythm Xience Acquisition, the Company recorded a contingent consideration liability of $13.4 million for potential payments if certain regulatory approval and revenue milestones are achieved. During the year ended December 31, 2020, the Company issued 119,993 shares of Series D convertible preferred stock (since converted to common stock) and paid $2.5 million of contingent consideration. The Company paid $0.9 million and $3.4 million of contingent consideration in the years ended December 31, 2022 and 2021, respectively. The contingent consideration liability is recorded on the consolidated balance sheets at fair value. For the years ended December 31, 2022 and 2021, the Company recorded a $1.1 million increase and $3.7 million decrease, respectively, for the change in fair value of contingent consideration in the consolidated statements of operations and comprehensive loss. As of December 31, 2022, the fair value of the contingent consideration liability on the consolidated balance sheets is $1.8 million.

Sale of Business

Sale of Business	12 Months Ended
Sale of Business	Dec. 31, 2022
Discontinued Operations and Disposal Groups [Abstract]
Sale of Business	Sale of Business On June 30, 2022, the Company completed the First Closing in accordance with the Asset Purchase Agreement with Medtronic, pursuant to which the Company agreed to sell to Medtronic certain transseptal access and sheath assets which make up the Company's left-heart access portfolio (and which comprised the Rhythm Xience product line acquired as part of the Rhythm Xience Acquisition). The assets transferred to Medtronic upon the First Closing (the “Assets”) include patents, trademarks, patent and trademark applications, know-how, copyrights, prototypes and other intellectual property owned or licensed by the Company, business records and documents (including regulatory and clinical materials) and manufacturing equipment related to the AcQCross® line of sheath-compatible septal crossing devices, AcQGuide® MINI integrated crossing device and sheath, AcQGuide® FLEX Steerable Introducer with integrated transseptal dilator and needle and AcQGuide® VUE steerable sheaths . Pursuant to the Asset Purchase Agreement, Medtronic paid $50.0 million at the First Closing, of which $4.0 million was paid into an indemnity escrow account for a period of 18 months following the First Closing to secure indemnification obligations of the Company under the Asset Purchase Agreement and recorded as restricted cash on the consolidated balance sheets as of December 31, 2022. The Company is also eligible to receive the following contingent cash consideration pursuant to the Asset Purchase Agreement: (i) $20.0 million upon its completion, to the reasonable satisfaction of Medtronic, of certain conditions set forth in the Asset Purchase Agreement relating to the Company becoming a qualified supplier of Medtronic for the Products, including demonstration of ISO 14971:2019 compliance, completion of certain test method validations and compliance with certain other reporting requirements (the "OEM Earnout"); (ii) $17.0 million upon the earlier of (A) the Second Closing or (B) the Company’s initial submission for CE Mark certification of the Products under the European Union Medical Devices Regulation to the reasonable satisfaction of a third-party regulatory consultant, subject to certain other conditions as set forth in the Asset Purchase Agreement; and (iii) amounts equal to 100%, 75%, 50% and 50%, respectively, of quarterly Net Sales (as defined in the Asset Purchase Agreement) from sales of the Products achieved by Medtronic over each year over four years beginning on the first full quarter after Medtronic’s first commercial sale of a Product and achievement of the OEM Earnout. The $20.0 million OEM Earnout was achieved on October 31, 2022 and payment was received in November 2022, of which $1.6 million is held in escrow and recorded as restricted cash on the consolidated balance sheets. The $17.0 million Transfer Earnout was achieved as of December 31, 2022 and recorded as a receivable on the consolidated balance sheets. Payment was received from Medtronic on January 14, 2023. No amounts under item (iii) were earned or received as of December 31, 2022. With the achievement of the OEM Earnout Conditions (as defined in the Asset Purchase Agreement) and upon notice from Medtronic, Medtronic became the Company's exclusive distributor of the Products under the Distribution Agreement in connection with the Asset Purchase Agreement. The Company recorded the following amounts in 2022, resulting in a net gain of $79.5 million related to the sale of business to Medtronic, calculated as the difference between the non-contingent consideration received, less direct transaction costs and the net carrying amount of the assets sold (in thousands): Non-contingent cash consideration received under the First Closing $ 50,000 OEM Earnout received in November 2022 20,000 Transfer Earnout accrued as of December 31, 2022 and received in January 2023 17,000 Property and equipment sold, net (498) Intangible assets sold, net (3,010) Transaction costs (4,027) Gain on sale of business $ 79,465 The sale was accounted for as a derecognition of a group of assets that is a business pursuant to ASC 810 - Consolidation , with the resulting gain classified as operating income within loss from operations on the consolidated statements of operations and comprehensive loss. The sale does not represent a strategic shift having a major effect on the Company's operations and financial results and, consequently, does not qualify as a discontinued operation.

Marketable Securities

Marketable Securities	12 Months Ended
Marketable Securities	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Marketable Securities	Marketable Securities Marketable securities consist of the following as of December 31, 2022 and 2021 (in thousands): December 31, 2022 Amortized Gross Gross Fair Value Available-for-sale securities - short-term: U.S. treasury securities $ 26,906 $ 3 $ (12) $ 26,897 Commercial paper 3,200 2 — 3,202 Yankee debt securities 14,764 — — 14,764 Total available-for-sale securities - short-term 44,870 5 (12) 44,863 Total available-for-sale securities $ 44,870 $ 5 $ (12) $ 44,863 December 31, 2021 Amortized Gross Gross Fair Value Available-for-sale securities - short-term: Corporate debt securities $ 15,786 $ — $ (6) $ 15,780 U.S. treasury securities 5,073 — (9) 5,064 Commercial paper 36,759 — — 36,759 Yankee debt securities 3,941 — (9) 3,932 Supranational 3,054 — (3) 3,051 Asset-backed securities 12,128 — (12) 12,116 Total available-for-sale securities - short-term 76,741 — (39) 76,702 Available-for-sale securities - long-term Corporate debt securities 3,082 — (2) 3,080 Asset-backed securities 4,044 — (4) 4,040 Total available-for-sale securities - long-term 7,126 — (6) 7,120 Total available-for-sale securities $ 83,867 $ — $ (45) $ 83,822

Inventory

Inventory	12 Months Ended
Inventory	Dec. 31, 2022
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory as of December 31, 2022 and 2021 consists of the following (in thousands): December 31, 2022 December 31, 2021 Raw materials $ 9,179 $ 6,779 Work in process 2,025 1,772 Finished goods 2,123 7,857 Total inventory $ 13,327 $ 16,408 Inventory is recorded net of write-downs and manufacturing scrap of $3.8 million and $1.3 million for the years ended December 31, 2022 and 2021.

Lessor Sales-Type Leases

Lessor Sales-Type Leases	12 Months Ended
Lessor Sales-Type Leases	Dec. 31, 2022
Leases [Abstract]
Lessor Sales-Type Leases	Lessor Sales-Type Leases The Company recognizes revenue and costs, as well as a lease receivable, at the commencement of embedded sales-type leases within its deferred equipment agreements. Lease revenue related to sales-type leases was $0.3 million and $1.2 million for the years ended December 31, 2022 and 2021, respectively, and is included within revenue As of December 31, 2022 and 2021, a balance of $0.6 million and $0.9 million, respectively, is recorded for short-term leases receivable in prepaid expenses and other current assets on the consolidated balance sheets, and a balance of $0.5 million and $0.7 million, respectively, for long-term lease receivable is recorded in other assets related to sales-type leases . The following table is an estimation of maturities of customer sales-type lease receivables for each of the following years as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 616 Year ending December 31, 2024 368 Year ending December 31, 2025 127 Total maturities of customer sales-type leases $ 1,111

Property and Equipment, Net

Property and Equipment, Net	12 Months Ended
Property and Equipment, Net	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	Property and Equipment, Net The following table summarizes the Company’s property and equipment, net, as of December 31, 2022 and 2021 (in thousands): December 31, 2022 December 31, 2021 Medical diagnostic equipment $ 14,826 $ 16,759 Furniture and fixtures 432 433 Office equipment 1,556 1,538 Laboratory equipment and software 5,148 5,302 Leasehold improvements 580 582 Construction in process 2,166 958 Total property and equipment 24,708 25,572 Less: accumulated depreciation (15,487) (11,902) Property and equipment, net $ 9,221 $ 13,670 Property and equipment includes certain medical diagnostic equipment and AcQMap Systems located at customer premises. The Company retains ownership of the equipment and has the right to remove the equipment if it is not being used according to expectations. The Company records the cost of equipment to cost of sales on the consolidated statements of operations and comprehensive loss when it is subsequently sold or the Company enters into a sales-type lease agreement. See Note 7—Lessor Sales-Type Leases for additional details. Depreciation expense was $6.1 million and $5.8 million for the years ended December 31, 2022 and 2021, respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	12 Months Ended
Goodwill and Intangible Assets	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets The following table presents goodwill and intangible assets activity during the years ended December 31, 2022 and 2021 (in thousands): Goodwill Intangible Balance, December 31, 2020 $ 12,026 $ 5,653 Amortization expense — (640) Balance, December 31, 2021 12,026 5,013 Amortization Expense — (420) Impairment (12,026) — Intangible assets disposed in sale (1) — (3,010) Balance, December 31, 2022 $ — $ 1,583 ____________________ (1) Intangible assets were reduced by $3.0 million related to the sale of business to Medtronic. See Note 4 - Sale of Business . Goodwill Impairment During the first quarter of 2022, the Company experienced a significant decline in stock price which reduced the market capitalization below the carrying value of the Company. The Company performed a quantitative assessment of the fair value of its reporting unit. The assessment used a combination of quoted market prices as well as present value calculations which included both the income and market approach. Based on the assessment, the Company concluded that the fair value of the reporting unit was less than its carrying amount by an amount that resulted in the Company fully impairing its goodwill balance of $12.0 million during the year ended December 31, 2022. Intangible Assets The tables below present the details of intangible assets as of December 31, 2022 and 2021 (dollars in thousands): December 31, 2022 Estimated Weighted Intangible Accumulated Balance Licensed intangibles 10.0 7.9 $ 2,000 $ (417) $ 1,583 Total intangible assets $ 2,000 $ (417) $ 1,583 December 31, 2021 Estimated Weighted Intangible Accumulated Balance Developed technology 10 7.6 $ 4,200 $ (1,020) $ 3,180 Customer-related intangible 5 2.5 100 (50) 50 Licensed intangibles 10 8.9 2,000 (217) 1,783 Total intangible assets $ 6,300 $ (1,287) $ 5,013 The Company recorded amortization expense related to intangible assets of $0.4 million and $0.6 million for the years ended December 31, 2022 and 2021, respectively. For the years ended December 31, 2022 and 2021, the Company determined that there was no impairment of intangible assets. Developed technology and customer related intangibles were disposed during the year ended December 31, 2022 as part of the sale to Medtronic. See Note 4 - Sale of Business for additional details. The following table presents the future amortization expense associated with amortizable intangible assets as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 200 Year ending December 31, 2024 200 Year ending December 31, 2025 200 Year ending December 31, 2026 200 Year ending December 31, 2027 200 Thereafter 583 Total future amortization $ 1,583

Accrued Liabilities

Accrued Liabilities	12 Months Ended
Accrued Liabilities	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued Liabilities	Accrued Liabilities The following table presents details of accrued liabilities as of December 31, 2022 and 2021 (in thousands): December 31, December 31, Compensation and related expenses $ 6,919 $ 7,088 Professional fees 126 158 Deferred revenue 326 401 Sales and use tax 639 71 Clinical studies 390 541 Clinician Council payable 216 358 Accrued royalties 159 129 Accrued restructuring 45 — Other 866 350 Total accrued liabilities $ 9,686 $ 9,096

Debt

Debt	12 Months Ended
Debt	Dec. 31, 2022
Debt Instruments [Abstract]
Debt	Debt Outstanding debt as of December 31, 2022 and 2021 consists of the following (in thousands): December 31, December 31, 2022 Credit Agreement (1) $ 36,776 $ — 2019 Credit Agreement (2) — 44,550 Total outstanding debt under credit agreements 36,776 44,550 Less: Unamortized debt discount and fees (2,342) (4,135) Total outstanding debt, long-term $ 34,434 $ 40,415 ____________________ (1) The 2022 Credit Agreement includes final payment fees of $1.8 million. (2) The 2019 Credit Agreement includes final payment fees of $4.6 million 2019 Credit Agreement On May 20, 2019, the Company entered into the 2019 Credit Agreement which provided the Company with a senior term loan facility in aggregate principal amount of $70.0 million, of which the Company borrowed $40.0 million upon closing. The 2019 Credit Agreement bore interest per annum at LIBOR plus 7.75% and the principal amount of the obligation was due on May 20, 2024. The 2019 Credit Agreement provided for final payment fees of an additional $4.6 million due upon prepayment, upon the maturity date or upon acceleration. In connection with the issuance of the 2019 Credit Agreement, the Company issued liability-classified warrants (the "2019 Warrants") with a fair value of $0.9 million to purchase 419,992 shares of Series C convertible preferred stock at $16.67 per share. These warrants were subsequently automatically converted into warrants to purchase an equal number of shares of the Company’s Series D convertible preferred stock at $16.67 per share and were automatically converted into warrants to purchase an equal number of shares of common stock at $16.67 per share. The Company’s obligations under the 2019 Credit Agreement were secured by substantially all of its assets, including its intellectual property, and was guaranteed by Acutus NV. The 2019 Credit Agreement contained customary affirmative and negative covenants, including with respect to the Company’s ability to enter into fundamental transactions, to incur additional indebtedness, to grant liens, to pay dividends or to make distributions to its holders, to make investments and to merge or consolidate with any other person or engage in transactions with its affiliates, but did not include any financial covenants other than a minimum liquidity requirement. On June 30, 2022, the 2019 Credit Agreement was modified and resulted in an extinguishment of the debt. This transaction resulted in a loss on extinguishment of $7.9 million. See 2022 Credit Agreement section below for more details. 2022 Credit Agreement On June 30, 2022, the Company amended and restated the 2019 Credit Agreement. The 2022 Credit Agreement is with new lenders consisting of certain affiliates of Deerfield Management Company and is for an aggregate principal amount of $35.0 million with a five-year term. Proceeds from the 2022 Credit Agreement, along with cash on hand, were used to repay the 2019 Credit Agreement and to pay related fees and expenses. The 2022 Credit Agreement bears an annual interest of 9% plus the one-month adjusted term Secured Overnight Financing Rate (applying a 2.5% minimum rate). From date of closing, amortization payments are due as follows: • 15% of the principal due at the end of month 36; • 15% of the principal due at the end of month 48; and • 70% due at the end of month 60. The 2022 Credit Agreement is subject to prepayment penalties. The 2022 Credit Agreement provides for final payment fees of an additional $1.8 million due upon prepayment, on the maturity date or upon acceleration. The 2022 Credit Agreement is secured by a first-priority perfected lien on and security interest in substantially all of the Company’s existing and after-acquired tangible and intangible assets, subject to certain exceptions noted in the 2022 Credit Agreement. The 2022 Credit Agreement is subject to certain customary affirmative covenants, representations and warranties and other terms and conditions. It contains certain customary negative covenants including, but not limited to, restrictions on the Company’s ability and that of its subsidiaries to merge and consolidate with other companies, to incur indebtedness, to grant liens or security interests on assets, to pay dividends or make other restricted payments, to sell or otherwise transfer assets or to enter into transactions with affiliates. As of and for the year ended December 31, 2022, the Company was in compliance with all such covenants. In addition, the 2022 Credit Agreement includes customary events of default and other provisions that could require all amounts due thereunder to become immediately due and payable, either automatically or at the option of the lenders, if the Company fails to comply with terms. In connection with entering into the 2022 Credit Agreement, the Company entered into the 2022 Warrant Purchase Agreement with Deerfield, pursuant to which the Company issued to Deerfield warrants to purchase up to an aggregate 3,779,018 shares of common stock at an exercise price of $1.1114 per warrant share for a period of eight years following issuance. The 2022 Warrants represent a freestanding financial instrument and are conditionally puttable at the holder’s option upon an event that is outside of the Company’s control. Therefore, the 2022 Warrants are classified as liability pursuant to ASC 480, Distinguishing Liabilities from Equity , initially and subsequently recognized at fair value, with changes in fair value recognized in the Company's statement of operations and comprehensive loss. Refer to Fair Value Measurements in Note 2 - Summary of Significant Accounting Policies and Note 14 - Warrants for more information.

Operating Leases

Operating Leases	12 Months Ended
Operating Leases	Dec. 31, 2022
Leases [Abstract]
Operating Leases	Operating Leases The Company leases approximately 50,800 square feet of office space for its corporate headquarters and manufacturing facility in Carlsbad, California under a noncancelable operating lease that expires on December 31, 2027. The lease is subject to variable charges for common area maintenance and other costs that are determined annually based on actual costs. The base rent is subject to an annual increase each year. The Company has a renewal option for an additional five-year term upon the expiration date of the lease, which has been excluded from the calculation of the right-of-use asset as it is not reasonably certain to be exercised. Additionally, the Company leases approximately 3,900 square feet of office space in Zaventem, Belgium under a noncancelable operating lease that expires on December 31, 2024. The lease is subject to variable charges that are determined annually for common area maintenance and other costs based on actual costs, and base rent is subject to an annual increase each year based on an index rate. The following table summarizes quantitative information of the Company’s operating leases for the years ended December 31, 2022 and 2021 (dollars in thousands): Year Ended December 31, 2022 2021 Cash flows from operating leases $ 898 $ 853 Weighted average remaining lease term - operating leases 4.9 years 3.6 years Weighted average discount rate – operating leases 7.0% 7.0% The following table provides the components of the Company’s operating lease expense for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Operating lease cost $ 1,013 $ 950 Variable lease cost 293 325 Total operating lease expense $ 1,306 $ 1,275 The following table presents the future minimum payments under the non-cancelable operating leases as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 618 Year ending December 31, 2024 1,166 Year ending December 31, 2025 1,151 Year ending December 31, 2026 1,185 Year ending December 31, 2027 1,221 Total future minimum operating lease payments 5,341 Less: imputed interest (919) Total operating lease liability $ 4,422

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesThe Company and certain of its current and former officers have been named as defendants in two putative securities class action lawsuits filed in the United States District Court for the Southern District of California on February 14, 2022 and March 23, 2022. On July 19, 2022, the court consolidated the two actions, appointed a lead plaintiff and appointed lead counsel for the proposed class. On September 16, 2022, the lead plaintiff filed a consolidated amended complaint. The defendant thereafter filed a motion to dismiss. Due to the complex nature of the legal and factual issues involved in these class action matters, the outcome is not presently determinable and any loss is neither probable nor reasonably estimable.

Warrants

Warrants	12 Months Ended
Warrants	Dec. 31, 2022
Warrants and Rights Note Disclosure [Abstract]
Warrants	Warrants As of December 31, 2022 and 2021, the outstanding warrants to purchase the Company’s common stock consist of the following: Warrants Outstanding Exercise Price Expiration Date as of December 31, 2022 2021 Warrants issued in 2015 $5.25 01/30/2025 3,808 3,808 Warrants issued with 2018 Convertible Notes $0.10 06/07/2028 346,689 346,689 Warrants issued with 2018 Term Loan $16.67 07/31/2028 26,998 26,998 2019 Warrants $16.67 05/20/2029 419,992 419,992 2022 Warrants $1.11 6/30/2030 3,779,018 — Total warrants outstanding 4,576,505 797,487 The Company’s warrant activity for the years ended December 31, 2022 and 2021 is as follows: Warrants Weighted Weighted Balance - December 31, 2020 824,608 $9.10 7.9 Exercised, net (26,958) $0.10 6.2 Shares withheld for exercise price (163) $0.10 6.2 Balance - December 31, 2021 797,487 $9.41 5.9 Granted 3,779,018 $1.11 7.5 Balance - December 31, 2022 4,576,505 $2.56 7.2 The Company’s warrants provide the holder the option to purchase a specified number of shares for a specified price within a specified duration or upon the occurrence of a specific event. The holder may exercise the warrant either by cash payment or by exercise pursuant to a cashless exercise whereby a calculated number of shares are withheld upon exercise to satisfy the exercise price. The warrants do not provide the holder any voting rights until the warrants are exercised. In accordance with ASC 480, the 2022 Warrants are recorded at fair value on the consolidated balance sheets as a warrant liability. Changes in fair value are recognized as a change in fair value of warrant liability on the consolidated statements of operations and comprehensive loss. For the year ended December 31, 2022, the Company recognized a favorable change in fair value that was not material. In connection with the Series A Common Equivalent Preferred Stock Exchange Agreements, four warrant holders are limited to exercising their warrants such that following any such exercise, the number of shares of common stock beneficially owned by such holder cannot exceed 4.9% of the outstanding common stock of the Company (two of the holders may, at their option and upon sufficient prior written notice to the Company, increase such percentage to 9.9%). In the event the common share limit has been met and the holder chooses to exercise their warrants, the holder can sell any common stock they hold. Therefore, the amendment to the warrant agreements does not restrict the holder from fully exercising the warrants under the original terms of the warrant agreements. See Note 15 - Stockholders' Equity for additional details.

Stockholders_ Equity

Stockholders’ Equity	12 Months Ended
Stockholders’ Equity	Dec. 31, 2022
Equity [Abstract]
Stockholders’ Equity	Stockholders’ Equity Common Stock In July 2021, the Company issued 6,325,000 shares of common stock in a public offering, which included 825,000 shares of common stock issued upon the underwriter's exercise in full of an option to purchase additional shares of common stock. The price to the public for each share was $14.00 providing gross proceeds of $88.6 million. Net of underwriting discounts, commission and other offering expenses, the Company received $82.7 million from the offering. During the year ended December 31, 2022 and 2021, stock options to acquire 35,478 shares and 111,804 shares, respectively, were exercised for shares of the Company's common stock with proceeds of $0.1 million and $0.7 million, respectively. Additionally in conjunction with the 2020 Employee Stock Purchase Plan, during the year ended December 31, 2022 and 2021 149,327 shares and 33,641 shares, respectively, of common stock were issued for consideration of $0.2 million and $0.4 million, respectively. During the year ended December 31, 2022 and 2021, the Company issued 412,628 shares and 134,050 shares, respectively, of common stock upon vesting of RSUs, and the Company issued no shares and 186 shares, respectively, of common stock for RSAs. See Note 16 - Stock-Based Compensation for additional details. Series A Common Equivalent Preferred Stock In August 2021, the Company entered into exchange agreements (the “Exchange Agreements”) with four investors pursuant to which the investors exchanged 6,665,841 shares of the Company’s common stock for 6,666 shares of a new series of non-voting convertible preferred stock of the Company designated as “Series A Common Equivalent Preferred Stock,” par value $0.001 per share (the "Preferred Stock"). In connection with the issuance of the Preferred Stock pursuant to the Exchange Agreements, on August 23, 2021, the Company filed a Certificate of Designation of Preferences, Rights and Limitations of the Series A Common Equivalent Preferred Stock of the Company with the Secretary of State of the State of Delaware. The Preferred Stock ranks senior to the common stock with respect to rights on the distribution of assets on any voluntary or involuntary liquidation, dissolution or winding up of the affairs of the Company, having a liquidation preference equal to its par value of $0.001 per share. The Preferred Stock will participate equally and ratably on an as-converted basis with the holders of common stock in all cash dividends paid on the common stock. The Preferred Stock is non-voting. Upon election, each holder may convert each share of Preferred Stock into 1,000 shares of common stock, except to the extent that following such conversion the number of shares of common stock held by such holder, its affiliates and any other persons whose beneficial ownership of common stock would be aggregated with such holder’s for purposes of Section 13(d) of the Exchange Act including shares held by any “group” (as defined in Section 13(d) of the Exchange Act and applicable regulations of the Securities and Exchange Commission) of which such holder is a member, but excluding shares beneficially owned by virtue of the ownership of securities or rights to acquire securities that have limitations on the right to convert, exercise or purchase similar to the limitation set forth in the Series A Certificate of Designation, exceeds 4.9% (or, at the election of the holders, OrbiMed Private Investments IV, LP or OrbiMed Royalty Opportunities II, LP, made by delivering at least 61 days advance written notice to the Company of its intention to increase the beneficial ownership cap applicable to such holder, 9.9%) of the total number of shares of common stock then issued and outstanding.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
Stock-Based Compensation	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation 2022 Inducement Equity Incentive Plan The 2022 Inducement Equity Incentive Plan (the “2022 Plan”), permitting the granting of nonstatutory stock options, RSUs, RSAs, stock appreciation rights, performance share units ("PSUs"), performance shares and other equity-based awards to employees, directors and consultants, became effective on March 30, 2022. As of December 31, 2022, 6,000,000 shares of common stock were authorized for issuance under the 2022 Plan, of which 5,928,500 shares remain available for issuance. 2020 Equity Incentive Plan The 2020 Equity Incentive Plan (the “2020 Plan”), permitting the granting of non-statutory stock options, RSAs, RSUs, stock appreciation rights, PSUs, performance shares and other equity-based awards to employees, directors and consultants, became effective on August 5, 2020. As of December 31, 2022, 4,431,305 shares of common stock were authorized for issuance under the 2020 Plan including 1,118,288 shares that were authorized during the year ended 2022. As of December 31, 2022, 2,037,630 shares remain available for issuance under the 2020 Plan including shares that became available under the 2011 Equity Incentive Plan. 2011 Equity Incentive Plan The 2011 Equity Incentive Plan (the "2011 Plan") permits the granting of incentive stock options, non-statutory stock options, restricted stock, RSUs and other stock-based awards to employees, directors, officers and consultants. As of December 31, 2022, 1,319,968 shares of common stock were authorized for issuance under the 2011 Plan and no shares remain available for issuance. No additional awards will be granted under the 2011 Plan. Shares that become available for issuance from the outstanding awards under the 2011 Plan due to forfeiture or otherwise will become available for issuance of future awards under the 2020 Plan. Stock Options The stock options generally vest over four years and have a ten-year contractual term. The fair value of each employee and non-employee stock option grant is estimated on the date of grant using the Black-Scholes option pricing model. As the Company’s common stock began public trading in August 2020, the Company lacks company-specific historical and implied volatility information required for valuation. Consequently, the Company estimates its expected stock volatility based on the historical volatility of a publicly traded set of peer companies. Due to the lack of historical exercise history, the expected term of the Company’s stock options was determined using the "simplified method" for awards. The risk-free interest rate is determined by reference to the U.S. Treasury yield curve in effect at the time of grant for time periods approximately equal to the expected term of the award. Expected dividend yield is zero as the Company has never paid nor does it expect to pay any cash dividend in the foreseeable future. The following assumptions were used to estimate the fair value of stock option for the years ended December 31, 2022 and 2021: Year Ended December 31, 2022 2021 Risk-free interest rate 1.76 % - 3.39% 0.76 % - 1.39% Expected dividend yield —% —% Expected term in years 5.5 - 6.0 5.5 - 7.0 Expected volatility 75 % - 90% 60 % - 75% The following table summarizes stock option activity during the years ended December 31, 2022 and 2021: Number of Shares Weighted Weighted Aggregate Outstanding as of December 31, 2020 3,403,607 $13.32 8.1 $ 52,866 Options granted 1,196,281 $12.89 Options exercised (111,804) $6.36 $ 2,799 Options forfeited (706,448) $14.76 Outstanding as of December 31, 2021 (1) 3,781,636 $13.12 7.6 $ 93 Options granted 782,430 $1.48 Options exercised (35,478) $1.85 Options forfeited (1,629,767) $11.14 Outstanding as of December 31, 2022 2,898,821 $6.83 6.9 $ 79 Options vested and expected to vest December 31, 2022 2,898,821 $6.83 6.9 $ 79 Options exercisable December 31, 2022 1,744,253 $8.53 5.8 $ — ____________________ (1) The weighted average exercise price of stock options outstanding was $13.12 as of December 31, 2021. However, those same options after the July 15, 2022 stock option repricing have a weighted average exercise price of $9.75. The aggregate intrinsic year-end values in the table above reflects a value for options "in the money," which are options exercisable for a value less than the Company’s common stock price on the last day of the fiscal period of $1.15, $3.41 and $11.58 as of December 31, 2022, 2021 and 2020, respectively. The Company calculates the aggregate intrinsic value for such options as the product of the number of options outstanding multiplied by the difference between the per share fair value and the exercise price. The aggregate intrinsic value for options exercised in the above table represents the product of the number of options exercised multiplied by the difference between the per share fair value of the Company’s stock on the date of exercise and the exercise price. The weighted-average grant date fair value per share for the stock option grants during the years ended December 31, 2022, 2021 and 2020 was $1.33, $8.46 and $11.58, respectively. As of December 31, 2022, the total unrecognized compensation related to unvested stock option awards granted was $6.6 million, which the Company expects to recognize over a weighted-average period of approximately 1.5 years. Restricted Stock Units (RSUs) The following table summarizes the Company’s RSU activity for the years ended December 31, 2022 and 2021: Number Weighted Unvested as of December 31, 2020 545,466 $16.53 Granted 718,567 $12.25 Forfeited (117,430) $17.22 Vested (151,512) $15.77 Unvested as of December 31, 2021 995,091 $13.47 Granted 1,863,156 $1.76 Forfeited (690,059) $6.71 Vested (508,290) $10.11 Unvested as of December 31, 2022 1,659,898 $4.17 As of December 31, 2022, unrecognized compensation related to unvested RSUs was $5.1 million, which the Company expects to recognize over a weighted-average period of approximately 1.6 years. Restricted Stock Awards (RSAs) The following table summarizes the Company’s Restricted Stock Award ("RSA") activity for the year ended December 31, 2021 and the Company recorded no RSA activity for the year ended December 31, 2022: Number Weighted Unvested as of December 31, 2020 — — Granted 186 $14.75 Vested (186) $14.75 Unvested as of December 31, 2021 — — Employee Stock Purchase Plan (ESPP) The Company's 2020 ESPP permits individual employees to purchase shares of the Company’s common stock from amounts accumulated under payroll deductions. The ESPP became effective on August 5, 2020 wherein 645,105 shares of common were been authorized. Additional shares of common stock are allocated to the 2020 ESPP by the determination of the Compensation Committee of the Company’s Board of Directors, in its sole discretion, and by evergreen provisions in the plan authorization. Automatically authorized were 258,042 shares during 2022 under the plan's evergreen provision. As of December 31, 2022, 462,137 shares are available for purchase under the Company's 2020 ESPP. The 2020 ESPP is implemented in consecutive offering periods, with a new offering period commencing on the first trading day on or after February 1 and August 1 of each year and terminating on the last trading day on or before July 31 and January 31, respectively. For the current year, offering periods began on February 1 and August 1. In November 2021, the Company amended its ESPP offering periods, for those beginning after the January 31, 2022 purchase, to commence on the first trading day on or after May 15 and November 15 of each year and terminating on the last trading day on or before November 14 and May 14, respectively. On each purchase date which falls on the last date of each offering period, 2020 ESPP participants will purchase shares of common stock at a price per share equal to 85% of the lesser of (1) the fair market value per share of the common stock on the offering date or (2) the fair market value of the common stock on the purchase date. The occurrence and duration of offering periods under the 2020 ESPP are subject to the determination of the Compensation Committee of the Company’s Board of Directors, in its sole discretion. The fair value of the 2020 ESPP shares used in determining compensation expense is estimated using the Black-Scholes option pricing model. Stock Option Repricing On July 15, 2022, and in accordance with the terms of the Company’s 2011 Plan and 2020 Plan, the Company’s Board of Directors approved a stock option repricing (the “2022 Repricing”) wherein the exercise price of each Designated Option was to be reduced to the price of the Company’s common stock as of the market close on July 25, 2022. As of that date, the closing price of the Company's common stock was $1.34 per share. "Designated Option" is defined as all outstanding stock options to acquire shares of the Company’s common stock that were issued to active employees of the Company (not a non-employee member of the Board or a consultant) as of July 25, 2022. All outstanding options remain outstanding in accordance with their current terms and conditions. Upon modification, the Company recognized $0.3 million of additional stock-based compensation from vested options. As unvested options continue to vest, the Company anticipates the recognition of an additional $0.3 million of stock-based compensation expense from the date of the modification through 2025. Total Stock-Based Compensation The following table summarizes the total stock-based compensation expense for the stock options, RSUs, RSAs and ESPP expense recorded in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Cost of products sold $ 669 $ 864 Research and development 1,736 2,181 Selling, general and administrative 6,986 10,709 Total stock-based compensation $ 9,391 $ 13,754

Net Loss Per Common Share

Net Loss Per Common Share	12 Months Ended
Net Loss Per Common Share	Dec. 31, 2022
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common Share Basic net loss per common share is computed by dividing net loss attributable to common stockholders by the weighted-average number of shares of common stock outstanding for the period. Diluted net loss per common share excludes the potential impact of the Company’s convertible preferred stock, common stock options, RSUs, RSAs, intended ESPP purchases and warrants because the Company's net losses would cause such shares to be anti-dilutive. Therefore, as the Company recorded net losses loss in the periods presented, basic and diluted net loss per common share are the same. The table below provides potentially dilutive securities not included in the calculation of the diluted net loss per common share because to do so would be anti-dilutive: Year Ended December 31, 2022 2021 Shares issuable upon: Conversion of Series A Common Equivalent Preferred Stock 6,665,841 6,665,841 Exercise of common stock warrants 4,576,505 797,487 Exercise of stock options 1,744,253 3,781,636 Vesting of RSUs and RSAs 1,659,898 995,091 Issuance of shares under 2020 ESPP 51,730 — Total potentially dilutive securities 14,698,227 12,240,055

401(k) Retirement Plan

401(k) Retirement Plan	12 Months Ended
401(k) Retirement Plan	Dec. 31, 2022
Retirement Benefits [Abstract]
401(k) Retirement Plan	401(k) Retirement PlanThe Company has a 401(k) retirement savings plan that provides retirement benefits to substantially all full-time U.S. employees. Eligible employees may contribute a percentage of their annual compensation, subject to Internal Revenue Service limitations. The Company provided no contributions to the 401(k) retirement savings plan for the years ended December 31, 2022 and 2021.

Income Taxes

Income Taxes	12 Months Ended
Income Taxes	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The components of pretax loss from operations for the years ended December 31, 2022 and 2021 are as follows: December 31, 2022 2021 U.S. $ (39,346) $ (117,868) Foreign (188) 185 Pretax loss from operations $ (39,534) $ (117,683) The components of income tax expense for continuing operations are as follows: December 31, 2022 2021 Federal $ — $ — State 15 — Foreign 67 — Total provision for income taxes $ 82 $ — A provision for state and foreign income taxes was less than $0.1 million for the year ended December 31, 2022 and there was no provision for the year ended December 31, 2021. Current income taxes are based upon the year’s income taxable for federal, state and foreign tax reporting purposes. Deferred income taxes are provided for certain income and expenses which are recognized in different periods for tax and financial reporting purposes. Deferred tax assets and liabilities are computed for differences between the consolidated financial statements and tax bases of assets and liabilities that will result in taxable or deductible amounts in the future based on enacted tax laws and rates applicable to the period in which the differences are expected to affect taxable income, and NOL carryforwards and R&D tax credit carryforwards. The Company adopted ASU 2019-12 in the first quarter of 2021 and has recorded franchise taxes not based on income outside of income tax expense. The following table presents a reconciliation of income tax computed at the U.S. federal statutory tax rate to the total income tax expense for the years ended December 31, 2022 and 2021 (dollars in thousands): Year Ended December 31, 2022 2021 Amount Tax Rate Amount Tax Rate Income tax benefit at federal statutory rate $ (8,302) 21.0 % $ (24,714) 21.0 % Adjustments for tax effects of: State taxes, net (847) 2.1 % (2,343) 2.0 % Permanent adjustments 917 (2.3) % 352 (0.3) % Goodwill impairment 2,525 (6.4) % — — % Stock based compensation expense 2,525 (6.4) % — — % Research and development credit (2,099) 5.3 % (2,255) 1.9 % Unrecognized tax benefit 630 (1.6) % 676 (0.6) % Rate change — — % 532 (0.5) % Return to provision 534 (1.3) % — — % Other — — % 817 (0.6) % Valuation allowance 4,199 (10.6) % 26,935 (22.9) % Income tax expense $ 82 (0.2) % $ — — % Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2022 and 2021 are as follows (in thousands): December 31, 2022 2021 Deferred tax assets: Net operating losses $ 94,437 $ 93,668 Stock-based compensation 1,678 2,468 Research and development credit 10,273 8,803 Capitalized research costs 9,473 — Accrued compensation 1,161 432 Accrued expenses — 446 Intangible assets 92 3,564 Lease liability 1,019 1,114 Inventory 655 202 Other 35 11 Total gross deferred tax assets 118,823 110,708 Valuation allowance (110,907) (106,717) Net deferred tax asset 7,916 3,991 Deferred tax liabilities: Deferred installment gain (5,315) — Property and equipment (1,105) (1,986) Right of use assets (891) (1,009) Prepaid expenses (105) (593) Other (461) (313) Debt (39) (90) Total deferred tax liabilities (7,916) (3,991) Net deferred tax assets (liabilities) $ — $ — In assessing the realizability of deferred tax assets as of December 31, 2022 and 2021, management considered whether it is more likely than not that some portion or all of the deferred tax assets will be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible or the NOL carryforwards and R&D credit carryforwards will be used. The Company determined it is more likely than not that its net deferred tax assets will not be realized. Accordingly, a valuation allowance was recorded as of December 31, 2022 and 2021 to fully offset the net deferred tax assets of $110.9 million and $106.7 million, respectively. The following table presents NOLs and tax credit carryforwards as of December 31, 2022 (in thousands): Amount Expiration Years NOLs, federal (post-December 31, 2017) $ 309,325 Indefinite (1) NOLs, federal (pre-January 1, 2018) $ 108,165 2031 - 2037 NOLs, state $ 96,361 2026 - 2042 NOLs, state (post-December 31, 2017) $ 14,725 Indefinite (1) Research and development tax credits, federal $ 9,503 2031 - 2042 Research and development tax credits, California $ 6,548 Indefinite ____________________ (1) NOL carryforwards generated after 2017 can be carried forward indefinitely and can generally be used to offset up to 80% of future taxable income. NOL carryforwards may be subject to a substantial annual limitation due to ownership change limitations that may have occurred or that could occur in the future, as required by Section 382 of the Internal Revenue Code of 1986, as amended (the “Code”), as well as similar state and foreign provisions. These ownership changes may limit the amount of NOL and R&D credit carryforwards that can be used annually to offset future taxable income and tax, respectively. In general, an “ownership change” as defined by Section 382 of the Code results from a transaction or series of transactions over a three-year period resulting in an ownership change of more than 50% of the outstanding stock of a company by certain stockholders. The Company has not completed a study to assess whether an ownership change has occurred or whether there have been multiple ownership changes since the Company’s formation due to the complexity and cost associated with such study, and the fact that there may be additional such ownership changes in the future. Any limitation may result in expiration of a portion of the NOL carryforwards or research and development tax credit carryforwards before utilization; however, such limitation, if any, would not have an impact on the Company’s financial statement due to the full valuation. The Company conducts intensive research and experimentation activities, generating R&D tax credits for federal and state purposes under Section 41 of the Code. The Company has not performed a formal study validating these credits claimed in the tax returns. Once a study is prepared, the amount of R&D tax credits available could vary from what was originally claimed on the tax returns. The following table summarizes the changes to unrecognized tax benefits as of December 31, 2022 and 2021 (in thousands): December 31, 2022 2021 Balance at beginning of year $ 4,128 $ 3,397 Gross increases – tax positions in current period 683 731 Gross decreases – tax positions in prior period (16) — Balance at end of year $ 4,795 $ 4,128 As of December 31, 2022, the Company has unrecognized tax benefits of $4.8 million of which $4.4 million will affect the effective tax rate if recognized when the Company no longer has a valuation allowance offsetting its deferred tax assets. The Company does not anticipate that there will be a significant change in unrecognized tax benefits over the next 12 months. The Company is subject to U.S. federal and various state tax as well as Belgium tax jurisdictions. Since the Company formed in 2011, all filed tax returns are subject to examination. Generally, the tax years remain open for examination by the federal statute under a three-year statute of limitation; however, states generally keep their statutes open between three and four years. However, the Company’s tax years from inception are subject to examination by the United States and various state taxing authorities due to the carry forward of unused NOLs and R&D credits. The Company’s practice is to recognize interest and/or penalties related to income tax matters in income tax expense. The Company had no accrual for interest and penalties on its consolidated balance sheets and has not recognized interest and/or penalties in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 and 2021. The Tax Cuts and Jobs Act enacted in 2017 requires taxpayers to capitalize and amortize R&D expenditures for tax purposes incurred in tax years beginning after December 31, 2021. The rule resulted in the Company's capitalization of R&D expenditures of approximately $25.3 million incurred during 2022. For R&D performed in the U.S., the Company will amortize costs capitalized for tax purposes over 5 years and for R&D performed outside the U.S, the Company will amortize costs capitalized for tax purposes over 15 years. The Inflation Reduction Act 2022 incorporating a Corporate Alternative Minimum Tax ("CAMT") was signed into law on August 16, 2022. The changes will affect tax years beginning after December 31, 2022. The CAMT will require companies to make a new minimum tax calculation for federal income tax purposes and pay the greater of the new minimum tax or the regular tax liability. The Company is currently evaluating the provisions of the CAMT, however it is not expected to have any material impact for the Company. The Creating Helpful Incentives to Produce Semiconductors Act of 2022 ("CHIPS Act") was signed into law on August 9, 2022 to boost domestic semiconductor manufacturing and encourage U.S. research activities. The CHIPS Act provides for a 25% investment credit intended to promote the domestic production of semiconductors. The CHIPS Act is not expected to have any material impact for the Company.

Related Party Transactions

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2022
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions Grant and Vesting of Performance Share Units The August 2020 completion of the Company's IPO satisfied performance conditions for certain PSUs granted to the chairman of the Company’s board of directors. The Company recorded $4.6 million of stock-based compensation expense in the year ended December 31, 2021 related to the grant. Series A Common Equivalent Preferred Stock In August 2021, the Company entered into the Exchange Agreements with related parties Deerfield Private Design Fund III, L.P., Deerfield Partners, L.P., OrbiMed Private Investments IV, LP and OrbiMed Royalty Opportunities II, LP pursuant to which the investors exchanged 6,665,841 shares of the Company’s common stock for 6,666 shares of Series A Common Equivalent Preferred Stock, par value $0.001 per share. See Note 15 - Stockholders' Equity for additional details. Consulting Agreement The Company entered into a consulting agreement with the chairman of the Company’s board of directors. The Company recorded $0.2 million and $0.1 million of expense related to the agreement during the years ended December 31, 2022 and 2021, respectively. Credit Agreements The 2019 Credit Agreement was between the Company and related parties OrbiMed Royalty Opportunities II, LP and Deerfield Private Design Fund II, L.P., and provided for a loan of up to $70.0 million with a maturity date of May 20, 2024. On June 30, 2022, the loan balance of $40.0 million was repaid in full out of the proceeds of the 2022 Credit Agreement. The 2022 Credit Agreement with related parties Deerfield Private Design Fund III, L.P. and Deerfield Partners, L.P. replaced the 2019 Credit Agreement and provides for an aggregate principal amount of $35.0 million and a maturity date five years from the closing of the loan. Refer to Note 11 - Debt for additional details. The liability for the loan balance related to the 2022 Credit Agreement and the 2019 Credit Agreement recorded on the Company's consolidated balance sheets was $34.4 million and $40.4 million as of December 31, 2022 and 2021, respectively. The Company recorded interest expense related to the debt on the consolidated statement of operations and comprehensive loss of $5.1 million and $5.7 million for the years ended December 31, 2022 and 2021, respectively. Warrants In connection with the 2022 Credit Agreement, the Company entered into the 2022 Warrant Purchase Agreement with Deerfield, pursuant to which the Company issued warrants for the purchase up to an aggregate 3,779,018 shares of the Company’s common stock at an exercise price of $1.1114 per share for a period of eight years following issuance. Refer to Note 14 - Warrants for additional details.

Subsequent Events

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On January 10, 2023, the Company received a letter from The Nasdaq Stock Market LLC notifying the Company that it had regained compliance with Listing Rule 5450(a)(1), which requires that listed securities maintain a minimum closing bid price of at least $1.00 per share (the “Minimum Bid Requirement”). The Company regained compliance with the Minimum Bid Requirement based on the closing bid price of the Company’s common stock on the Nasdaq Global Select Market between December 23, 2022 and January 9, 2023. The Company had previously been notified of its non-compliance with the Minimum Bid Requirement on November 2, 2022, as described in the Company’s Current Report on Form 8-K filed on November 4, 2022. On March 10, 2023, the Company conducted an analysis of its financial exposure stemming from the failure of Silicon Valley Bank (“SVB”) and subsequent appointment of the Federal Deposit Insurance Corporation (the “FDIC”) as receiver and had assessed the Company’s exposure to be immaterial. On March 12, 2023, the Department of the Treasury, Board of Governors of the Federal Reserve System and the FDIC approved actions enabling the FDIC to complete its resolution of SVB in a manner that fully protects all depositors. We are confident that the Company will have full access to its cash and investments. Additionally, the Company is evaluating its financial business partners to ensure long-term security of its assets.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2022
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”).
Principles of Consolidation	Principles of Consolidation The consolidated financial statements include the accounts of Acutus Medical, Inc. and its wholly-owned subsidiary Acutus Medical NV (“Acutus NV”), which was incorporated under the laws of Belgium in August 2013. All intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates and Assumptions	Use of Estimates and Assumptions The preparation of the consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, expenses and disclosures of contingent assets and liabilities. These estimates and assumptions are based on current facts, historical experience and various other factors believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities and the recording of revenue and expenses that are not readily apparent from other sources. Actual results could differ from those estimates.
Segments	Segments Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker in making decisions regarding resource allocation and assessing performance. The Company views its operations and manages its business in one operating and reportable segment.
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with maturities of three months or less when purchased to be cash equivalents. All of the Company’s cash equivalents have liquid markets and high credit ratings. The Company maintains its cash in bank deposits and other accounts, the balances of which, at times and as of December 31, 2022 and 2021, exceeded federally insured limits. Restricted cash consists of (i) deposited cash collateral for the Company’s corporate credit card program and (ii) cash received for the sale of business to Medtronic held in an indemnity escrow account until certain terms of sale are met.
Marketable Securities	Marketable Securities The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities and Yankee debt securities. The Company considers its debt securities to be available-for-sale securities. Available-for-sale securities are initially classified as cash equivalents, short-term marketable securities or long-term marketable securities based on the maturity date at time of purchase and their availability to meet current operating requirements. Marketable securities that mature in three months or less from the date of purchase are classified as cash equivalents. Marketable securities excluding cash equivalents that mature in one year or less are classified as short-term available-for-sale securities and are reported as a component of current assets. Securities that are classified as available-for-sale are measured at fair value with temporary unrealized gains and losses reported in other comprehensive loss and as a component of stockholders’ equity until their disposition or maturity. The Company reviews all available-for-sale securities at each period end to determine if they remain available-for-sale based on the Company’s current intent and ability to sell the security if it is required to do so. Realized gains and losses from the sale of marketable securities, if any, are calculated using the specific-identification method. Marketable securities are subject to a periodic impairment review. The Company may recognize an impairment charge when a decline in the fair value of investments below the cost basis is determined to be other-than-temporary. In determining whether a decline in market value is other-than-temporary, various factors are considered including the cause, duration of time and severity of the impairment, any adverse changes in the investees’ financial condition and the Company’s intent and ability to hold the security for a period of time sufficient to allow for an anticipated recovery in market value. Declines in value judged to be other-than-temporary are included in the Company’s consolidated statements of operations and comprehensive loss. The Company recorded no other-than-temporary impairments related to marketable securities in the Company’s consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 and 2021.
Concentrations of Credit Risk and Off-Balance Sheet Risk	Concentrations of Credit Risk and Off-Balance Sheet RiskFinancial instruments that potentially subject the Company to credit risk consist principally of cash, cash equivalents, restricted cash, accounts receivable and marketable securities. Cash and restricted cash are maintained in accounts with financial institutions, which, at times may exceed the Federal depository insurance coverage of $0.25 million. The Company has not experienced losses on these accounts and management believes, based upon the quality of the financial institutions, that the credit risk with regard to these deposits is not significant.
Revenue from Contracts with Customers	Revenue from Contracts with Customers The Company accounts for revenue earned from contracts with customers under ASC 606, Revenue from Contracts with Customers (“ASC 606”), and ASC 842, Leases (“ASC 842”). The core principle of ASC 606 is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The following five steps are applied to achieve that core principle: • Step 1: Identify the contract with the customer. • Step 2: Identify the performance obligations in the contract. • Step 3: Determine the transaction price. • Step 4: Allocate the transaction price to the performance obligations in the contract. • Step 5: Recognize revenue when, or as, the company satisfies a performance obligation. ASC 842 provides guidance on determining whether an agreement contains a lease. ASC 842 defines a lease as a contract, or part of a contract, that conveys the right to control the use of identified property, plant or equipment for a period of time in exchange for consideration. For new customers, the Company places its medical diagnostic equipment, the AcQMap System, at customer sites under evaluation agreements, and generates revenue from the sale of disposable products used with the AcQMap System. Disposable products primarily include AcQMap Catheters and AcQGuide Steerable Sheaths. Outside of the U.S., the Company also has the Qubic Force Device which generates revenue from the sale of the AcQBlate FORCE Ablation Catheters. The Company provides the disposable products in exchange for consideration, which occurs when a customer submits a purchase order and the Company provides disposables at the agreed upon prices in the invoice. Generally, the AcQMap System is provided to the customer for free with no binding agreement or requirement to purchase any disposable products, and customers thereafter purchase disposable products using separate purchase orders. The Company has elected the practical expedient and accounting policy election to account for the shipping and handling as activities to fulfill the promise to transfer the disposable products and not as a separate performance obligation. Additionally, the Company sells the AcQMap System to customers along with software updates on a when-and-if-available basis, as well as the Qubic Force Device and a transseptal crossing line of products which can be used in a variety of heart procedures and does not need to be accompanied with an AcQMap System or Qubic Force Device. Included in the transseptal crossing line of products are primarily the AcQRef introducer sheath, the AcQGuide sheaths and the AcQCross Transseptal Dilator/Needle. The Company also enters into deferred equipment agreements that are generally structured such that the Company agrees to provide an AcQMap System at no up-front charge, with title of the device transferring to the customer at the end of the contract term in exchange for the customer’s commitment to purchase disposables at a specified price over the term of the agreement, which generally ranges from two Lastly, the Company enters into short-term operating leases for the rental of the AcQMap System after an evaluation. These lease agreements impose no requirement on the customer to purchase the equipment, and the equipment is not transferred to the customer at the end of the lease term. The short-term nature of the lease agreements does not result in lease payments accumulating to an amount that equals the value of the equipment nor is the lease term reflective of the economic life of the equipment. The Company’s contracts primarily include fixed consideration. Generally, there are no discounts, rebates, returns or other forms of variable consideration. Customers are generally required to pay within 30 to 60 days. The delivery of disposable products are performance obligations satisfied at a point in time. The disposable products are shipped free on board (“FOB”) shipping point or FOB destination. For disposable products that are shipped FOB shipping point, the customer has the significant risks and rewards of ownership and legal title to the assets when the disposable products leave the Company’s shipping facilities, thus the customer obtains control and revenue is recognized at that point in time. Revenue is recognized on delivery for disposable products shipped via FOB destination. For direct customers, the installation and delivery of the AcQMap System is satisfied at a point in time when the installation is complete, which is when the customer can benefit and has control of the system. For AcQMap System sales sold to Biotronik, the installation is not a performance obligation as it is performed by Biotronik, and therefore, the AcQMap System is satisfied at a point in time when they have control of the system. The Company’s software updates and equipment service performance obligations are satisfied evenly over time as the customer simultaneously receives and consumes the benefits of the Company’s performance for these services throughout the service period. The Company allocates the transaction price to each performance obligation identified in the contract based on the relative standalone selling price (“SSP”). The Company determines SSP for the purposes of allocating the transaction price to each performance obligation based on the adjusted market assessment approach that maximizes the use of observable inputs, which include, but are not limited to, sales transactions where the specific performance obligations are sold separately, company list prices and specific offers to customers. Except for the deferred equipment agreements noted above, the Company’s contracts with customers generally have an expected duration of one year or less, and therefore, the Company has elected the practical expedient in ASC 606 to not disclose information about its remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative (“SG&A”) expense as incurred due to the short duration of the Company’s contracts. The Company’s contract balances consisted solely of accounts receivable as of December 31, 2022 and 2021. In May 2020, the Company entered into Bi-Lateral Distribution Agreements with Biotronik. Pursuant to the Bi-Lateral Distribution Agreements, the Company obtained a non-exclusive license to distribute a range of Biotronik’s products and accessories in the United States, Canada, China, Hong Kong and multiple Western European countries under the Company’s private label. Moreover, if an investigational device exemption ("IDE") clinical trial is required for these products to obtain regulatory approval in the United States, or a clinical trial is required for these products to obtain regulatory approval in China, the Company will obtain an exclusive distribution right in such territories for a term of up to five years commencing on the date of regulatory approval if the Company covers the cost of the IDE or other clinical trial and the Company conducts such study within a specified period. Biotronik also agreed to distribute the Company’s products and accessories in Germany, Japan, Mexico, Switzerland and multiple countries in Asia-Pacific, Eastern Europe, the Middle East and South America. The Company also granted Biotronik a co-exclusive right to distribute these products in Hong Kong. Each party will pay a specified transfer price on the sale of the other party’s products and, accordingly, will earn a distribution margin on the sale of the other party’s products. In 2022, the Company sold the left-heart access transseptal crossing business to Medtronic. Under a Distribution Agreement, the Company will act as the OEM supplier of these products. The Company will produce and sell the products to Medtronic for
Inventory	Inventory Inventory is stated at the lower of cost (first-in, first-out basis) or net realizable value. The Company recorded write-downs for excess and obsolete inventory of $3.8 million and $1.3 million for the years ended December 31, 2022 and 2021, respectively, based on management’s review of inventories on hand, comparisons to estimated future usage and sales, observed shelf-life and assumptions about the likelihood of obsolescence.
Accounts Receivable	Accounts Receivable Trade accounts receivable are recorded net of allowances for uncollectible accounts. The Company evaluates the collectability of its accounts receivable based on various factors including historical experience, the length of time the receivables are past due and the financial health of the customer. The Company reserves specific receivables if collectability is no longer reasonably assured. Based upon the assessment of these factors, the Company did not record an allowance for uncollectible accounts as of December 31, 2022 or 2021. Pursuant to the Asset Purchase Agreement with Medtronic (see Note 4 - Sale of Business)
Employee Retention Credit Receivable	Employee Retention Credit Receivable The Employee Retention Credit is a refundable U.S. tax credit separate from tax based on income for businesses that continued to pay employees while shut down due to the COVID-19 pandemic or had significant declines in gross receipts from March 13, 2020 to December 31, 2021. The Company is an eligible employer qualifying under the program, applied for the tax credit in 2022 and is expecting receipt in the early part of 2023.
Property and Equipment, Net	Property and Equipment, Net Property and equipment is recorded at cost. Depreciation and amortization are provided using the straight-line method over the estimated useful lives of the related assets, generally three
Intangible Assets	Intangible AssetsIntangible assets consist of acquired developed technology and customer-related intangible assets acquired as part of the acquisition of Rhythm Xience. The Company’s intangible assets also include a license agreement with Biotronik. The Company determines the appropriate useful life of its finite-lived intangible assets by performing an analysis of expected cash flows of the acquired assets. Finite-lived intangible assets are amortized over their estimated useful lives using the straight-line method, which approximates the pattern in which the economic benefits are consumed. Acquired in-process technology is classified as a finite-lived intangible and amortized accordingly. Indefinite-lived intangible assets are tested for impairment at least annually and are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Indefinite-lived intangible assets are impaired if their estimated fair values are less than their carrying value.
Goodwill	Goodwill Goodwill represents the excess of the purchase price of an entity over the estimated fair value of the assets acquired and liabilities assumed. Under ASC 350, Intangibles – Goodwill and Other
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets The Company reviews long-lived assets, including property and equipment and finite-lived intangible assets, for impairment whenever events or changes in business circumstances indicate that the carrying amount of the assets may not be fully recoverable. An impairment loss is recognized when the asset’s carrying value exceeds the total undiscounted cash flows expected from its use and eventual disposition. The amount of the impairment loss is determined as the excess of the carrying value of the asset over its fair value. For the years ended December 31, 2022 and 2021, the Company determined that there was no impairment of property and equipment or intangible assets other than goodwill.
Foreign Currency Translation and Transactions	Foreign Currency Translation and Transactions The assets, liabilities and results of operations of Acutus NV are recorded using the Euro as the designated functional currency, which is the currency of the primary economic environment in which Acutus NV operates. Consequently, transactions in currencies other than Euro are measured and recorded in Euro. Upon consolidation with the Company, its assets and liabilities are translated to U.S. dollars at currency exchange rates as of the balance sheet date and its revenues and expenses are translated at the weighted-average currency exchange rates during the applicable reporting periods. Translation adjustments resulting from the process of translating this entity’s financial statements are reported in accumulated other comprehensive income (loss) in the
Lease Property	Lease Property The Company leases office space in Carlsbad, CA as its corporate headquarters and for manufacturing operations. Additionally, it leases office space in Zaventem, Belgium for international operations. The Company accounts for its lease property under ASC 842. Under this guidance, arrangements meeting the definition of a lease are classified as operating or financing leases, and are recorded on the consolidated balance sheet as both a right-of-use asset and a lease liability, calculated by discounting fixed lease payments over the lease term at the rate implicit in the lease or the Company’s incremental borrowing rate, which is the rate for collateralized borrowings based on the current economic environment, credit history, credit rating, value of leases, currency in which the lease obligation is satisfied, rate sensitivity, lease term and materiality . Lease liabilities are increased by interest and reduced by payments each period, and the right-of-use asset is amortized over the lease term. For operating leases, interest on the lease liability and the amortization of the right-of-use asset results in straight-line rent expense over the lease term. Variable lease expenses are recorded when incurred. In calculating the right-of-use asset and lease liability, the Company elected to combine lease and non-lease components. The Company adopted the policy election to exclude short-term leases having initial terms of twelve months from the initial recognition provisions of ASC 842. See Note 12 - Operating leases for additional details.
Cost of Products Sold	Cost of Products Sold Cost of products sold includes raw materials, direct labor, manufacturing overhead, shipping and receiving costs and other less significant indirect costs related to the production of the Company’s products.
Research and Development	Research and Development The Company is actively engaged in new product research and development efforts. Research and development expenses consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel directly engaged in research and development activities, clinical trial expenses, equipment costs, material costs, allocated rent and facilities costs and depreciation. Research and development expenses relating to possible future products are expensed as incurred. The Company also accrues and expenses costs for activities associated with clinical trials performed by third parties as incurred. All other costs relative to setting up clinical trial sites are expensed as incurred. Clinical trial site costs related to patient enrollment are accrued as patients are entered into the trials.
Selling, General and Administrative	Selling, General and Administrative SG&A consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel in sales, executive, finance and other administrative functions, allocated rent and facilities costs, legal fees relating to intellectual property and corporate matters, professional fees for accounting and consulting services, marketing costs and insurance costs. The Company expenses all SG&A costs as incurred.
Fair Value Measurements	Fair Value Measurements Financial Instruments Fair value measurements are based on the premise that fair value is an exit price representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the following three-tier fair value hierarchy is used in determining the inputs for measuring fair value: Level 1—Quoted prices in active markets for identical assets or liabilities. Level 2—Observable inputs other than Level 1 prices for similar assets or liabilities that are directly or indirectly observable in the marketplace. Level 3—Unobservable inputs which are supported by little or no market activity and consist of financial instruments valued using pricing models, discounted cash flow methodologies or similar techniques, as well as instruments for which the determination of fair value requires significant judgment or estimation. Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Management’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed or initial amounts recorded may not be indicative of the amount that the Company or holders of the instruments could realize in a current market exchange. There were no transfers made among the three levels in the fair value hierarchy for the years ended December 31, 2022 and 2021. As of December 31, 2022 and 2021, the Company’s cash (excluding cash equivalents which are recorded at fair value on a recurring basis), restricted cash, accounts receivable, accounts payable and accrued expenses were carried at cost, which approximates the fair values due to the short-term nature of each instrument. The carrying amount of the Company’s long-term debt approximates fair value due to its variable market interest rate and management’s opinion that current rates and terms that would be available to the Company with the same maturity and security structure would be essentially equivalent to that of the Company’s long-term debt. The fair value of the Company’s money market funds is determined using quoted market prices in active markets for identical assets. The fair value for the available-for-sale marketable securities is determined based on valuation models using inputs that are observable either directly or indirectly (Level 2 inputs) such as quoted prices for similar assets, yield curve, volatility factors, credit spreads, default rates, loss severity, current market and contractual prices for the underlying instruments, broker and dealer quotes, as well as other relevant economic measures. Unrealized gains and losses associated with liabilities within the Level 3 category include changes in fair value that were attributable to both observable (e.g., changes in market interest rates) and unobservable (e.g., changes in unobservable long-dated volatilities) inputs. Contingent Consideration
Stock-Based Compensation	Stock-Based Compensation The Company accounts for all stock-based payments to employees and non-employees, including grants of stock options, RSU, and RSAs, to be recognized in the consolidated financial statements based on their respective grant date fair values. The Company estimates the fair value of stock option grants using the Black-Scholes option pricing model. The RSUs and RSAs, are valued based on the fair value of the Company’s common stock on the date of grant. The Company expenses stock-based compensation related to stock options, RSUs and RSAs over the requisite service period. All stock-based compensation costs are recorded in cost of products sold, research and development expense or SG&A expense in the consolidated statements of operations and comprehensive loss based upon the respective employee’s or non-employee’s roles within the Company. Forfeitures are recorded as they occur. See Note 16—Stock-Based Compensation for additional details.
Income Taxes	Income Taxes Income taxes are recorded in accordance with ASC 740, Income Taxes (“ASC 740”), which provides for deferred taxes using an asset and liability approach. The Company recognizes deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements or tax returns. Deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse, and NOL carryforwards and R&D tax credit carryforwards. Valuation allowances are provided if, based upon the weight of available evidence, it is more likely than not that some or all of the deferred tax assets will not be realized. The Company accounts for uncertain tax positions in accordance with the provisions of ASC 740. When uncertain tax positions exist, the Company recognizes the tax benefit of tax positions to the extent that the benefit would more likely than not be realized assuming examination by the taxing authority. The determination as to whether the tax benefit will more likely than not be realized is based upon the technical merits of the tax position as well as consideration of the available facts and circumstances. To date, there have been no interest or penalties charged in relation to the unrecognized tax benefits. See Note 19—Income Taxes for additional details.
Warrant Liability	Warrant Liability The Company accounts for certain common stock warrants outstanding as a liability at fair value, determined using the Black-Scholes option pricing model, on the consolidated balance sheets in accordance with ASC 815, Derivatives and Hedging (“ASC 815”). The liability is subject to re-measurement at each reporting period and any change in fair value is recognized in the consolidated statements of operations and comprehensive loss. See Note 14—Warrants for additional details.
Business Combinations	Business Combinations The Company accounts for business acquisitions using the acquisition method of accounting based on ASC 805, Business Combinations (“ASC 805”), which requires recognition and measurement of all identifiable assets acquired and liabilities assumed at their fair value as of the date control is obtained. The Company determines the fair value of assets acquired and liabilities assumed based upon its best estimates of the acquisition-date fair value of assets acquired and liabilities assumed in the acquisition. Goodwill is calculated as the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired. See Note 3 - Asset Acquisition and Business Combination for additional details.
Recently Adopted Accounting Pronouncements and Accounting Pronouncements to Be Adopted	Recently Adopted Accounting Pronouncements In May 2021, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2021-05, Leases (Topic 842), Lessors – Certain Leases with Variable Lease Payments ("ASU 2021-05"), which clarifies that lessors should classify and account for a lease with variable lease payments that do not depend on a reference index or a rate as an operating lease. This ASU is effective for smaller reporting companies in 2022. The Company adopted ASU 2021-05 in the first quarter of 2022 with no material impact on the consolidated financial statements. In April 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt Modifications and Extinguishments (Subtopic 470-50), Compensation Stock Compensation (Topic 718), and Derivatives and Hedging Contracts in Entity’s Own Equity (Subtopic 815-40) ("ASU 2021-04"), which provides clarification on how to account for a modification or exchange of free-standing equity-classified written call options that remain equity classified after the modification or exchange. ASU 2021-04 is effective for smaller reporting companies in 2022. The Company adopted the guidance in the first quarter of 2022 with no material impact on the consolidated financial statements. Accounting Pronouncements to Be Adopted In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326) ("ASU 2016-13"). ASU 2016-13 sets forth a “current expected credit loss” model which requires the Company to measure all expected credit losses for financial instruments held at the reporting date based on historical experience, current conditions and reasonable supportable forecasts. This replaces the existing incurred loss model and is applicable to the measurement of credit losses on financial assets measured at amortized cost, available-for-sale debt securities and applies to certain off-balance sheet credit exposures. ASU 2016-13 is effective for smaller reporting companies in 2023. The Company is currently assessing the impact of the adoption of ASU 2016-13 on the consolidated financial statements, however it has recognized no credit losses since inception and expects the adoption to have minimal, if any, impact.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
Summary of Significant Accounting Policies (Tables)	Dec. 31, 2022
Accounting Policies [Abstract]
Summary of Cash and Cash Equivalents and Restricted Cash	The following table reconciles cash and restricted cash in the consolidated balance sheets to the totals shown on the consolidated statements of cash flows (in thousands). December 31, 2022 December 31, 2021 Cash and cash equivalents $ 25,584 $ 24,071 Restricted cash 5,764 150 Total cash, cash equivalents and restricted cash $ 31,348 $ 24,221
Summary of Cash and Cash Equivalents and Restricted Cash	The following table reconciles cash and restricted cash in the consolidated balance sheets to the totals shown on the consolidated statements of cash flows (in thousands). December 31, 2022 December 31, 2021 Cash and cash equivalents $ 25,584 $ 24,071 Restricted cash 5,764 150 Total cash, cash equivalents and restricted cash $ 31,348 $ 24,221
Summary of Disaggregation of Revenue	The following table sets forth the Company’s revenue for disposables, systems, and service/other for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Disposables $ 12,922 $ 11,938 Systems 1,750 4,058 Service/Other 1,691 1,267 Total revenue $ 16,363 $ 17,263
Summary of Revenue from External Customers by Geographic Areas	The following table provides revenue by geographic location for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 United States $ 8,707 $ 8,325 Outside the United States 7,656 8,938 Total revenue $ 16,363 $ 17,263
Summary of Accounts Receivable	Accounts receivable recorded on the consolidated balance sheets for the years ended December 31, 2022 and 2021 consists of the following (in thousands): December 31, 2022 December 31, 2021 Trade accounts receivable $ 4,085 $ 3,633 Transfer earnout receivable 17,000 — Total accounts receivable $ 21,085 $ 3,633
Summary of Fair Value, Liabilities Measured on Recurring Basis	The following tables classify the Company’s financial assets and liabilities measured at fair value on a recurring basis into the fair value hierarchy as of December 31, 2022 and 2021 (in thousands): As of December 31, 2022 Quoted Significant Significant Total Assets included in: Cash and cash equivalents Money market securities $ 22,700 $ — $ — $ 22,700 Marketable securities at fair value U.S. treasury securities — 26,897 — 26,897 Commercial paper — 14,764 — 14,764 Yankee debt securities — 3,202 — 3,202 Total fair value $ 22,700 $ 44,863 $ — $ 67,563 Liabilities included in: Warrant liability $ — $ — $ 3,346 $ 3,346 Contingent consideration — — 1,800 1,800 Total fair value $ — $ — $ 5,146 $ 5,146 As of December 31, 2021 Quoted Significant Significant Total Assets included in: Cash and cash equivalents Money market securities $ 21,893 $ — $ — $ 21,893 Marketable securities at fair value Corporate debt securities — 18,860 — 18,860 U.S. treasury securities — 5,064 — 5,064 Commercial paper — 36,759 — 36,759 Yankee debt securities — 3,932 — 3,932 Supranational — 3,051 — 3,051 Asset-backed securities — 16,156 — 16,156 Total fair value $ 21,893 $ 83,822 $ — $ 105,715 Liabilities included in: Contingent consideration $ — $ — $ 2,000 $ 2,000 Total fair value $ — $ — $ 2,000 $ 2,000
Summary of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following table presents changes in Level 3 liabilities measured at fair value for the years ended December 31, 2022 and 2021 (in thousands): Contingent Warrant Liability Balance, December 31, 2020 $ 9,300 Payment of contingent consideration (3,435) Escrow release (1) (119) Change in fair value (3,746) Balance, December 31, 2021 $ 2,000 $ — Payment of contingent consideration (872) — Escrow release (1) (381) — Issuance of common stock warrants (2) — 3,313 Change in fair value 1,053 33 Balance, December 31, 2022 $ 1,800 $ 3,346 ____________________ (1) As part of the Rhythm Xience acquisition (see Note 3 - Asset Acquisition and Business Combination) , the first $0.5 million earned related to revenue success payments was paid at the end of the first month following the end of the quarter in which the revenue success payments were earned, into an escrow account until the expiration of an additional 18 month hold-back period commencing with the end of the quarter during which such revenue success payment amounts were earned. Amounts noted above were released from the escrow account. (2) Common stock warrants issued to lenders under the 2022 Credit Agreement (see Note 11 - Debt and Note 14 - Warrants ).
Weighted Average Unobservable Inputs to Measure Contingent Consideration	The weighted-average (in aggregate) significant unobservable inputs (Level 3 inputs) used in measuring the contingent consideration from the acquisition of Rhythm Xience as of December 31, 2022 and December 31, 2021 were as follows: December 31, 2022 December 31, 2021 Risk-free interest rate 4.8% 0.6% Expected term in years 1.0 - 2.0 1.0 - 2.0 Expected volatility 28.0% 28.8%
Schedule of Warrant Activity	The fair value was estimated to be $0.8853 per warrant as of December 31, 2022 and the significant inputs used in the estimation of the fair value were as follows: Risk-free interest rate 3.96% Expected term in years 7.5 Expected volatility 80.0% As of December 31, 2022 and 2021, the outstanding warrants to purchase the Company’s common stock consist of the following: Warrants Outstanding Exercise Price Expiration Date as of December 31, 2022 2021 Warrants issued in 2015 $5.25 01/30/2025 3,808 3,808 Warrants issued with 2018 Convertible Notes $0.10 06/07/2028 346,689 346,689 Warrants issued with 2018 Term Loan $16.67 07/31/2028 26,998 26,998 2019 Warrants $16.67 05/20/2029 419,992 419,992 2022 Warrants $1.11 6/30/2030 3,779,018 — Total warrants outstanding 4,576,505 797,487 The Company’s warrant activity for the years ended December 31, 2022 and 2021 is as follows: Warrants Weighted Weighted Balance - December 31, 2020 824,608 $9.10 7.9 Exercised, net (26,958) $0.10 6.2 Shares withheld for exercise price (163) $0.10 6.2 Balance - December 31, 2021 797,487 $9.41 5.9 Granted 3,779,018 $1.11 7.5 Balance - December 31, 2022 4,576,505 $2.56 7.2

Sale of Business (Tables)

Sale of Business (Tables)	12 Months Ended
Sale of Business (Tables)	Dec. 31, 2022
Discontinued Operations and Disposal Groups [Abstract]
Summary of Sale of Discontinued Operation	The Company recorded the following amounts in 2022, resulting in a net gain of $79.5 million related to the sale of business to Medtronic, calculated as the difference between the non-contingent consideration received, less direct transaction costs and the net carrying amount of the assets sold (in thousands): Non-contingent cash consideration received under the First Closing $ 50,000 OEM Earnout received in November 2022 20,000 Transfer Earnout accrued as of December 31, 2022 and received in January 2023 17,000 Property and equipment sold, net (498) Intangible assets sold, net (3,010) Transaction costs (4,027) Gain on sale of business $ 79,465

Marketable Securities (Tables)

Marketable Securities (Tables)	12 Months Ended
Marketable Securities (Tables)	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Summary of Marketable Securities	Marketable securities consist of the following as of December 31, 2022 and 2021 (in thousands): December 31, 2022 Amortized Gross Gross Fair Value Available-for-sale securities - short-term: U.S. treasury securities $ 26,906 $ 3 $ (12) $ 26,897 Commercial paper 3,200 2 — 3,202 Yankee debt securities 14,764 — — 14,764 Total available-for-sale securities - short-term 44,870 5 (12) 44,863 Total available-for-sale securities $ 44,870 $ 5 $ (12) $ 44,863 December 31, 2021 Amortized Gross Gross Fair Value Available-for-sale securities - short-term: Corporate debt securities $ 15,786 $ — $ (6) $ 15,780 U.S. treasury securities 5,073 — (9) 5,064 Commercial paper 36,759 — — 36,759 Yankee debt securities 3,941 — (9) 3,932 Supranational 3,054 — (3) 3,051 Asset-backed securities 12,128 — (12) 12,116 Total available-for-sale securities - short-term 76,741 — (39) 76,702 Available-for-sale securities - long-term Corporate debt securities 3,082 — (2) 3,080 Asset-backed securities 4,044 — (4) 4,040 Total available-for-sale securities - long-term 7,126 — (6) 7,120 Total available-for-sale securities $ 83,867 $ — $ (45) $ 83,822

Inventory (Tables)

Inventory (Tables)	12 Months Ended
Inventory (Tables)	Dec. 31, 2022
Inventory Disclosure [Abstract]
Summary of Inventory	Inventory as of December 31, 2022 and 2021 consists of the following (in thousands): December 31, 2022 December 31, 2021 Raw materials $ 9,179 $ 6,779 Work in process 2,025 1,772 Finished goods 2,123 7,857 Total inventory $ 13,327 $ 16,408

Lessor Sales-Type Leases (Table

Lessor Sales-Type Leases (Tables)	12 Months Ended
Lessor Sales-Type Leases (Tables)	Dec. 31, 2022
Leases [Abstract]
Estimated Future Maturities of Customer Sales-Type Lease Receivables	The following table is an estimation of maturities of customer sales-type lease receivables for each of the following years as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 616 Year ending December 31, 2024 368 Year ending December 31, 2025 127 Total maturities of customer sales-type leases $ 1,111

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	12 Months Ended
Property and Equipment, Net (Tables)	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Summary of Property and Equipment, Net	The following table summarizes the Company’s property and equipment, net, as of December 31, 2022 and 2021 (in thousands): December 31, 2022 December 31, 2021 Medical diagnostic equipment $ 14,826 $ 16,759 Furniture and fixtures 432 433 Office equipment 1,556 1,538 Laboratory equipment and software 5,148 5,302 Leasehold improvements 580 582 Construction in process 2,166 958 Total property and equipment 24,708 25,572 Less: accumulated depreciation (15,487) (11,902) Property and equipment, net $ 9,221 $ 13,670

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	12 Months Ended
Goodwill and Intangible Assets (Tables)	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Summary of Goodwill and Intangible Assets Activities	The following table presents goodwill and intangible assets activity during the years ended December 31, 2022 and 2021 (in thousands): Goodwill Intangible Balance, December 31, 2020 $ 12,026 $ 5,653 Amortization expense — (640) Balance, December 31, 2021 12,026 5,013 Amortization Expense — (420) Impairment (12,026) — Intangible assets disposed in sale (1) — (3,010) Balance, December 31, 2022 $ — $ 1,583 ____________________ (1) Intangible assets were reduced by $3.0 million related to the sale of business to Medtronic. See Note 4 - Sale of Business .
Summary of Finite Lived Intangible Assets	The tables below present the details of intangible assets as of December 31, 2022 and 2021 (dollars in thousands): December 31, 2022 Estimated Weighted Intangible Accumulated Balance Licensed intangibles 10.0 7.9 $ 2,000 $ (417) $ 1,583 Total intangible assets $ 2,000 $ (417) $ 1,583 December 31, 2021 Estimated Weighted Intangible Accumulated Balance Developed technology 10 7.6 $ 4,200 $ (1,020) $ 3,180 Customer-related intangible 5 2.5 100 (50) 50 Licensed intangibles 10 8.9 2,000 (217) 1,783 Total intangible assets $ 6,300 $ (1,287) $ 5,013
Summary of Remaining Amortization Expense	The following table presents the future amortization expense associated with amortizable intangible assets as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 200 Year ending December 31, 2024 200 Year ending December 31, 2025 200 Year ending December 31, 2026 200 Year ending December 31, 2027 200 Thereafter 583 Total future amortization $ 1,583

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	12 Months Ended
Accrued Liabilities (Tables)	Dec. 31, 2022
Payables and Accruals [Abstract]
Summary of Accrued Liabilities	The following table presents details of accrued liabilities as of December 31, 2022 and 2021 (in thousands): December 31, December 31, Compensation and related expenses $ 6,919 $ 7,088 Professional fees 126 158 Deferred revenue 326 401 Sales and use tax 639 71 Clinical studies 390 541 Clinician Council payable 216 358 Accrued royalties 159 129 Accrued restructuring 45 — Other 866 350 Total accrued liabilities $ 9,686 $ 9,096

Debt (Tables)

Debt (Tables)	12 Months Ended
Debt (Tables)	Dec. 31, 2022
Debt Instruments [Abstract]
Summary of Outstanding Debt	Outstanding debt as of December 31, 2022 and 2021 consists of the following (in thousands): December 31, December 31, 2022 Credit Agreement (1) $ 36,776 $ — 2019 Credit Agreement (2) — 44,550 Total outstanding debt under credit agreements 36,776 44,550 Less: Unamortized debt discount and fees (2,342) (4,135) Total outstanding debt, long-term $ 34,434 $ 40,415 ____________________ (1) The 2022 Credit Agreement includes final payment fees of $1.8 million. (2) The 2019 Credit Agreement includes final payment fees of $4.6 million

Operating Leases (Tables)

Operating Leases (Tables)	12 Months Ended
Operating Leases (Tables)	Dec. 31, 2022
Leases [Abstract]
Summary of Quantitative Information About Operating Leases and Components of Lease Cost	The following table summarizes quantitative information of the Company’s operating leases for the years ended December 31, 2022 and 2021 (dollars in thousands): Year Ended December 31, 2022 2021 Cash flows from operating leases $ 898 $ 853 Weighted average remaining lease term - operating leases 4.9 years 3.6 years Weighted average discount rate – operating leases 7.0% 7.0% The following table provides the components of the Company’s operating lease expense for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Operating lease cost $ 1,013 $ 950 Variable lease cost 293 325 Total operating lease expense $ 1,306 $ 1,275
Summary of Future Minimum Payments Under the Non-cancelable Operating Leases	The following table presents the future minimum payments under the non-cancelable operating leases as of December 31, 2022 (in thousands): Year ending December 31, 2023 $ 618 Year ending December 31, 2024 1,166 Year ending December 31, 2025 1,151 Year ending December 31, 2026 1,185 Year ending December 31, 2027 1,221 Total future minimum operating lease payments 5,341 Less: imputed interest (919) Total operating lease liability $ 4,422

Warrants (Tables)

Warrants (Tables)	12 Months Ended
Warrants (Tables)	Dec. 31, 2022
Warrants and Rights Note Disclosure [Abstract]
Schedule of Outstanding Warrants to Purchase the Company's Common Stock	The fair value was estimated to be $0.8853 per warrant as of December 31, 2022 and the significant inputs used in the estimation of the fair value were as follows: Risk-free interest rate 3.96% Expected term in years 7.5 Expected volatility 80.0% As of December 31, 2022 and 2021, the outstanding warrants to purchase the Company’s common stock consist of the following: Warrants Outstanding Exercise Price Expiration Date as of December 31, 2022 2021 Warrants issued in 2015 $5.25 01/30/2025 3,808 3,808 Warrants issued with 2018 Convertible Notes $0.10 06/07/2028 346,689 346,689 Warrants issued with 2018 Term Loan $16.67 07/31/2028 26,998 26,998 2019 Warrants $16.67 05/20/2029 419,992 419,992 2022 Warrants $1.11 6/30/2030 3,779,018 — Total warrants outstanding 4,576,505 797,487 The Company’s warrant activity for the years ended December 31, 2022 and 2021 is as follows: Warrants Weighted Weighted Balance - December 31, 2020 824,608 $9.10 7.9 Exercised, net (26,958) $0.10 6.2 Shares withheld for exercise price (163) $0.10 6.2 Balance - December 31, 2021 797,487 $9.41 5.9 Granted 3,779,018 $1.11 7.5 Balance - December 31, 2022 4,576,505 $2.56 7.2

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
Stock-Based Compensation (Tables)	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Schedule of Estimate of the Fair Value of Stock Option	The following assumptions were used to estimate the fair value of stock option for the years ended December 31, 2022 and 2021: Year Ended December 31, 2022 2021 Risk-free interest rate 1.76 % - 3.39% 0.76 % - 1.39% Expected dividend yield —% —% Expected term in years 5.5 - 6.0 5.5 - 7.0 Expected volatility 75 % - 90% 60 % - 75%
Summary of Stock Option Activity	The following table summarizes stock option activity during the years ended December 31, 2022 and 2021: Number of Shares Weighted Weighted Aggregate Outstanding as of December 31, 2020 3,403,607 $13.32 8.1 $ 52,866 Options granted 1,196,281 $12.89 Options exercised (111,804) $6.36 $ 2,799 Options forfeited (706,448) $14.76 Outstanding as of December 31, 2021 (1) 3,781,636 $13.12 7.6 $ 93 Options granted 782,430 $1.48 Options exercised (35,478) $1.85 Options forfeited (1,629,767) $11.14 Outstanding as of December 31, 2022 2,898,821 $6.83 6.9 $ 79 Options vested and expected to vest December 31, 2022 2,898,821 $6.83 6.9 $ 79 Options exercisable December 31, 2022 1,744,253 $8.53 5.8 $ — ____________________ (1) The weighted average exercise price of stock options outstanding was $13.12 as of December 31, 2021. However, those same options after the July 15, 2022 stock option repricing have a weighted average exercise price of $9.75.
Schedule of PSU and RSA Activity	The following table summarizes the Company’s RSU activity for the years ended December 31, 2022 and 2021: Number Weighted Unvested as of December 31, 2020 545,466 $16.53 Granted 718,567 $12.25 Forfeited (117,430) $17.22 Vested (151,512) $15.77 Unvested as of December 31, 2021 995,091 $13.47 Granted 1,863,156 $1.76 Forfeited (690,059) $6.71 Vested (508,290) $10.11 Unvested as of December 31, 2022 1,659,898 $4.17
Schedule of RSA Activity	The following table summarizes the Company’s Restricted Stock Award ("RSA") activity for the year ended December 31, 2021 and the Company recorded no RSA activity for the year ended December 31, 2022: Number Weighted Unvested as of December 31, 2020 — — Granted 186 $14.75 Vested (186) $14.75 Unvested as of December 31, 2021 — —
Summary of Stock-Based Compensation Expense for the Stock Options, PSUs, RSAs, and ESPP Expense	The following table summarizes the total stock-based compensation expense for the stock options, RSUs, RSAs and ESPP expense recorded in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 and 2021 (in thousands): Year Ended December 31, 2022 2021 Cost of products sold $ 669 $ 864 Research and development 1,736 2,181 Selling, general and administrative 6,986 10,709 Total stock-based compensation $ 9,391 $ 13,754

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	12 Months Ended
Net Loss Per Common Share (Tables)	Dec. 31, 2022
Earnings Per Share [Abstract]
Summary of Calculation of the Diluted Net Loss per Common Share	The table below provides potentially dilutive securities not included in the calculation of the diluted net loss per common share because to do so would be anti-dilutive: Year Ended December 31, 2022 2021 Shares issuable upon: Conversion of Series A Common Equivalent Preferred Stock 6,665,841 6,665,841 Exercise of common stock warrants 4,576,505 797,487 Exercise of stock options 1,744,253 3,781,636 Vesting of RSUs and RSAs 1,659,898 995,091 Issuance of shares under 2020 ESPP 51,730 — Total potentially dilutive securities 14,698,227 12,240,055

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
Income Taxes (Tables)	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Schedule of Components of Pretax Loss from Operation	The components of pretax loss from operations for the years ended December 31, 2022 and 2021 are as follows: December 31, 2022 2021 U.S. $ (39,346) $ (117,868) Foreign (188) 185 Pretax loss from operations $ (39,534) $ (117,683)
Schedule of Components of Income Tax Expense for Continuing Operations	The components of income tax expense for continuing operations are as follows: December 31, 2022 2021 Federal $ — $ — State 15 — Foreign 67 — Total provision for income taxes $ 82 $ —
Schedule of Reconciliation of Expected Tax Computed at U.S. Statutory Federal Income Tax Rate to Total Expense for Income Taxes	The following table presents a reconciliation of income tax computed at the U.S. federal statutory tax rate to the total income tax expense for the years ended December 31, 2022 and 2021 (dollars in thousands): Year Ended December 31, 2022 2021 Amount Tax Rate Amount Tax Rate Income tax benefit at federal statutory rate $ (8,302) 21.0 % $ (24,714) 21.0 % Adjustments for tax effects of: State taxes, net (847) 2.1 % (2,343) 2.0 % Permanent adjustments 917 (2.3) % 352 (0.3) % Goodwill impairment 2,525 (6.4) % — — % Stock based compensation expense 2,525 (6.4) % — — % Research and development credit (2,099) 5.3 % (2,255) 1.9 % Unrecognized tax benefit 630 (1.6) % 676 (0.6) % Rate change — — % 532 (0.5) % Return to provision 534 (1.3) % — — % Other — — % 817 (0.6) % Valuation allowance 4,199 (10.6) % 26,935 (22.9) % Income tax expense $ 82 (0.2) % $ — — %
Schedule of Components of Company's Deferred Tax Assets and Liabilities	Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2022 and 2021 are as follows (in thousands): December 31, 2022 2021 Deferred tax assets: Net operating losses $ 94,437 $ 93,668 Stock-based compensation 1,678 2,468 Research and development credit 10,273 8,803 Capitalized research costs 9,473 — Accrued compensation 1,161 432 Accrued expenses — 446 Intangible assets 92 3,564 Lease liability 1,019 1,114 Inventory 655 202 Other 35 11 Total gross deferred tax assets 118,823 110,708 Valuation allowance (110,907) (106,717) Net deferred tax asset 7,916 3,991 Deferred tax liabilities: Deferred installment gain (5,315) — Property and equipment (1,105) (1,986) Right of use assets (891) (1,009) Prepaid expenses (105) (593) Other (461) (313) Debt (39) (90) Total deferred tax liabilities (7,916) (3,991) Net deferred tax assets (liabilities) $ — $ —
Schedule of NOLs and Tax Credit Carryforwards	The following table presents NOLs and tax credit carryforwards as of December 31, 2022 (in thousands): Amount Expiration Years NOLs, federal (post-December 31, 2017) $ 309,325 Indefinite (1) NOLs, federal (pre-January 1, 2018) $ 108,165 2031 - 2037 NOLs, state $ 96,361 2026 - 2042 NOLs, state (post-December 31, 2017) $ 14,725 Indefinite (1) Research and development tax credits, federal $ 9,503 2031 - 2042 Research and development tax credits, California $ 6,548 Indefinite ____________________ (1) NOL carryforwards generated after 2017 can be carried forward indefinitely and can generally be used to offset up to 80% of future taxable income.
Schedule of Changes to Unrecognized Tax Benefits	The following table summarizes the changes to unrecognized tax benefits as of December 31, 2022 and 2021 (in thousands): December 31, 2022 2021 Balance at beginning of year $ 4,128 $ 3,397 Gross increases – tax positions in current period 683 731 Gross decreases – tax positions in prior period (16) — Balance at end of year $ 4,795 $ 4,128

Organization and Description _2

Organization and Description of Business (Details) - USD ($) $ / shares in Units, $ in Thousands				1 Months Ended		12 Months Ended
	Jan. 13, 2023	Jun. 30, 2022	Aug. 10, 2020	Nov. 30, 2022	Jul. 31, 2021	Dec. 31, 2022	Dec. 31, 2021
Subsidiary, Sale of Stock [Line Items]
Cash, cash equivalents, and short-term investments						$ 70,400	$ 107,900
Net loss						39,616	117,683
Net cash used in operating activities						85,032	99,682
Accumulated deficit						518,314	478,698
Working capital						98,000	107,800
Number of shares issued during the period (in shares)					6,325,000
Proceeds from issuance of common stock, net of issuance costs					$ 82,700	$ 0	$ 82,657
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Subsidiary, Sale of Stock [Line Items]
Consideration received		$ 50,000		$ 20,000
Restricted cash, long-term		$ 4,000		$ 1,600
Indemnity escrow account term		18 months
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Subsequent Event
Subsidiary, Sale of Stock [Line Items]
Consideration received	$ 17,000
IPO
Subsidiary, Sale of Stock [Line Items]
Proceeds from IPO			$ 166,300
Over-Allotment Option
Subsidiary, Sale of Stock [Line Items]
Number of shares issued during the period (in shares)					825,000
Price per share (in dollars per share)					$ 14
Public Stock Offering
Subsidiary, Sale of Stock [Line Items]
Sale of stock, consideration received on transaction					$ 88,600

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Narrative (Details)		1 Months Ended	12 Months Ended
	Jun. 30, 2022 USD ($)	Nov. 30, 2022 USD ($)	Dec. 31, 2022 USD ($) segment	Dec. 31, 2021 USD ($)
Summary of Significant Accounting Policies [Line Items]
Number of operating segments \| segment			1
Number of reportable segments \| segment			1
Other-than-temporary impairments related to marketable securities			$ 0	$ 0
Cash, FDIC insured amount			250,000
Inventory write-down			3,800,000	1,300,000
Allowance for uncollectible accounts			0	0
Goodwill impairment			12,026,000	0
Impairment of PPE			0	0
Intangible asset impairment			$ 0	$ 0
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Summary of Significant Accounting Policies [Line Items]
Non-contingent cash consideration received under the First Closing	$ 50,000,000	$ 20,000,000
Minimum
Summary of Significant Accounting Policies [Line Items]
Customers payment period			30 days
Property and equipment, estimated useful lives			3 years
Maximum
Summary of Significant Accounting Policies [Line Items]
Customers payment period			60 days
Contracts with customers, expected duration			1 year
Agreement to produce and sell products, term			4 years
Property and equipment, estimated useful lives			5 years
Deferred Equipment Agreements \| Minimum
Summary of Significant Accounting Policies [Line Items]
Contract with customer, contract term			2 years
Deferred Equipment Agreements \| Maximum
Summary of Significant Accounting Policies [Line Items]
Contract with customer, contract term			4 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Summary of Cash and Restricted Cash (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Cash and cash equivalents	$ 25,584	$ 24,071
Restricted cash	5,764	150
Total cash, cash equivalents and restricted cash	$ 31,348	$ 24,221	$ 25,384

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Summary of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 16,363	$ 17,263
Disposables
Summary of Significant Accounting Policies [Line Items]
Total revenue	12,922	11,938
Systems
Summary of Significant Accounting Policies [Line Items]
Total revenue	1,750	4,058
Service/Other
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 1,691	$ 1,267

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Summary of Revenue from External Customers by Geographic Areas (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 16,363	$ 17,263
United States
Summary of Significant Accounting Policies [Line Items]
Total revenue	8,707	8,325
Outside the United States
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 7,656	$ 8,938

Summary of Significant Accoun_8

Summary of Significant Accounting Policies - Summary of Accounts Receivable (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 21,085	$ 3,633
Trade accounts receivable
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	4,085	3,633
Transfer earnout receivable
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 17,000	$ 0

Summary of Significant Accoun_9

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Assets included in:
Available-for-sale securities	$ 44,863	$ 83,822
Total fair value	67,563	105,715
Liabilities included in:
Total fair value	5,146	2,000
Warrant liability
Liabilities included in:
Total fair value	3,346
Contingent consideration
Liabilities included in:
Total fair value	1,800	2,000
Money market securities
Assets included in:
Money market securities	22,700	21,893
Corporate debt securities
Assets included in:
Available-for-sale securities		18,860
U.S. treasury securities
Assets included in:
Available-for-sale securities	26,897	5,064
Commercial paper
Assets included in:
Available-for-sale securities	14,764	36,759
Yankee debt securities
Assets included in:
Available-for-sale securities	3,202	3,932
Supranational
Assets included in:
Available-for-sale securities		3,051
Asset-backed securities
Assets included in:
Available-for-sale securities		16,156
Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets included in:
Total fair value	22,700	21,893
Liabilities included in:
Total fair value	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Warrant liability
Liabilities included in:
Total fair value	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Contingent consideration
Liabilities included in:
Total fair value	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Money market securities
Assets included in:
Money market securities	22,700	21,893
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Corporate debt securities
Assets included in:
Available-for-sale securities		0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Commercial paper
Assets included in:
Available-for-sale securities	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Yankee debt securities
Assets included in:
Available-for-sale securities	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Supranational
Assets included in:
Available-for-sale securities		0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Asset-backed securities
Assets included in:
Available-for-sale securities		0
Significant Other Observable Inputs (Level 2)
Assets included in:
Total fair value	44,863	83,822
Liabilities included in:
Total fair value	0	0
Significant Other Observable Inputs (Level 2) \| Warrant liability
Liabilities included in:
Total fair value	0
Significant Other Observable Inputs (Level 2) \| Contingent consideration
Liabilities included in:
Total fair value	0	0
Significant Other Observable Inputs (Level 2) \| Money market securities
Assets included in:
Money market securities	0	0
Significant Other Observable Inputs (Level 2) \| Corporate debt securities
Assets included in:
Available-for-sale securities		18,860
Significant Other Observable Inputs (Level 2) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	26,897	5,064
Significant Other Observable Inputs (Level 2) \| Commercial paper
Assets included in:
Available-for-sale securities	14,764	36,759
Significant Other Observable Inputs (Level 2) \| Yankee debt securities
Assets included in:
Available-for-sale securities	3,202	3,932
Significant Other Observable Inputs (Level 2) \| Supranational
Assets included in:
Available-for-sale securities		3,051
Significant Other Observable Inputs (Level 2) \| Asset-backed securities
Assets included in:
Available-for-sale securities		16,156
Significant Unobservable Inputs (Level 3)
Assets included in:
Total fair value	0	0
Liabilities included in:
Total fair value	5,146	2,000
Significant Unobservable Inputs (Level 3) \| Warrant liability
Liabilities included in:
Total fair value	3,346
Significant Unobservable Inputs (Level 3) \| Contingent consideration
Liabilities included in:
Total fair value	1,800	2,000
Significant Unobservable Inputs (Level 3) \| Money market securities
Assets included in:
Money market securities	0	0
Significant Unobservable Inputs (Level 3) \| Corporate debt securities
Assets included in:
Available-for-sale securities		0
Significant Unobservable Inputs (Level 3) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	0	0
Significant Unobservable Inputs (Level 3) \| Commercial paper
Assets included in:
Available-for-sale securities	0	0
Significant Unobservable Inputs (Level 3) \| Yankee debt securities
Assets included in:
Available-for-sale securities	$ 0	0
Significant Unobservable Inputs (Level 3) \| Supranational
Assets included in:
Available-for-sale securities		0
Significant Unobservable Inputs (Level 3) \| Asset-backed securities
Assets included in:
Available-for-sale securities		$ 0

Summary of Significant Accou_10

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Payments for contingent consideration		$ 872	$ 3,435
Rhythm Xience
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Payments for contingent consideration		900	3,400
Rhythm Xience \| Earnout Consideration
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Payments for contingent consideration	$ 500	7,200
Indemnity escrow account term	18 months
Contingent Consideration \| Significant Unobservable Inputs (Level 3)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at beginning of period		2,000	9,300
Payment of contingent consideration		(872)	(3,435)
Escrow release		(381)	(119)
Issuance of common stock warrants		0
Change in fair value		1,053	(3,746)
Balance at end of period	$ 1,800	1,800	2,000
Warrant liability \| Significant Unobservable Inputs (Level 3)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at beginning of period		0
Payment of contingent consideration		0
Escrow release		0
Issuance of common stock warrants		3,313
Change in fair value		33
Balance at end of period	$ 3,346	$ 3,346	$ 0

Summary of Significant Accou_11

Summary of Significant Accounting Policies - Summary of Weighted Average Fair Value Assumptions on Contingent Consideration (Details) - Significant Unobservable Inputs (Level 3) - Rhythm Xience	Dec. 31, 2022	Dec. 31, 2021
Risk-free interest rate
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, fair value inputs	0.048	0.006
Expected term in years \| Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, fair value inputs	1	1
Expected term in years \| Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, fair value inputs	2	2
Expected volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, fair value inputs	0.280	0.288

Summary of Significant Accou_12

Summary of Significant Accounting Policies - Schedule of Warrant Activity (Details) - Exercise of common stock warrants - Significant Unobservable Inputs (Level 3)	Dec. 31, 2022 year $ / shares
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Share price (in dollars per share) \| $ / shares	$ 0.8853
Risk-free interest rate
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Warrants and rights outstanding, measurement input	0.0396
Expected term in years
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Warrants and rights outstanding, measurement input \| year	7.5
Expected volatility
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Warrants and rights outstanding, measurement input	0.800

Asset Acquisition and Busines_2

Asset Acquisition and Business Combination - Narrative (Details) - USD ($) $ in Thousands		1 Months Ended	3 Months Ended	12 Months Ended
	Jun. 18, 2019	Jul. 31, 2019	Dec. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Payments for contingent consideration				$ 872	$ 3,435
Change in fair value of contingent consideration				1,053	(3,746)
Intellectual Property \| Biotronik Asset Acquisition
Business Acquisition [Line Items]
Consideration transferred		$ 15,000
Biotronik Asset Acquisition
Business Acquisition [Line Items]
Payments for contingent consideration				2,000
Contingent milestone and royalty payments			$ 8,000	8,000	8,000
Biotronik Asset Acquisition \| Maximum
Business Acquisition [Line Items]
Potential milestone payments payable			10,000	10,000
Accrued liabilities			100	100
Rhythm Xience
Business Acquisition [Line Items]
Payments for contingent consideration				900	3,400
Consideration paid in cash	$ 3,000
Contingent consideration liability	13,400		1,800	1,800
Change in fair value of contingent consideration				1,100	$ (3,700)
Rhythm Xience \| Earnout Consideration
Business Acquisition [Line Items]
Potential milestone payments payable	$ 17,000
Payments for contingent consideration			$ 500	$ 7,200
Rhythm Xience \| Series D Convertible Preferred Stocks
Business Acquisition [Line Items]
Payments for contingent consideration						$ 2,500
Business consideration, number of equity interests issued and issuable (in shares)						119,993

Sale of Business - Narrative (D

Sale of Business - Narrative (Details) - Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations - Left-Heart Access Portfolio - USD ($) $ in Thousands		1 Months Ended	3 Months Ended
	Jun. 30, 2022	Nov. 30, 2022	Mar. 31, 2024	Dec. 31, 2023
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Non-contingent cash consideration received under the First Closing	$ 50,000	$ 20,000
Restricted cash, long-term	$ 4,000	$ 1,600
Indemnity escrow account term	18 months
Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, period			4 years
Year one \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage				100%
Year two \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage				75%
Year three \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage				50%
Year four \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage				50%

Sale of Business - Summary of S

Sale of Business - Summary of Sale of Discontinued Operation (Details) - USD ($) $ in Thousands			1 Months Ended
	Jan. 13, 2023	Jun. 30, 2022	Nov. 30, 2022	Dec. 31, 2022
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Disposal Group, Not Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration]		Gain on sale of business, net
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Non-contingent cash consideration received under the First Closing		$ 50,000	$ 20,000
Contingent consideration		20,000
Property and equipment sold, net		(498)
Intangible assets sold, net		(3,010)		$ (3,000)
Transaction costs		(4,027)
Gain on sale of business		$ 79,465
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Subsequent Event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Non-contingent cash consideration received under the First Closing	$ 17,000

Marketable Securities - Summary

Marketable Securities - Summary of Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Available-for-sale securities - short-term:
Amortized Cost	$ 44,870	$ 76,741
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax	5	0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax	(12)	(39)
Fair Value	44,863	76,702
Available-for-sale securities - long-term:
Amortized Cost		7,126
Gross Unrealized Gains		0
Gross Unrealized Losses		(6)
Fair Value		7,120
Total available-for-sale securities
Amortized Cost	44,870	83,867
Gross Unrealized Gains	5	0
Gross Unrealized Losses	(12)	(45)
Fair Value	44,863	83,822
Corporate debt securities
Available-for-sale securities - short-term:
Amortized Cost		15,786
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax		0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax		(6)
Fair Value		15,780
Available-for-sale securities - long-term:
Amortized Cost		3,082
Gross Unrealized Gains		0
Gross Unrealized Losses		(2)
Fair Value		3,080
U.S. treasury securities
Available-for-sale securities - short-term:
Amortized Cost	26,906	5,073
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax	3	0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax	(12)	(9)
Fair Value	26,897	5,064
Commercial paper
Available-for-sale securities - short-term:
Amortized Cost	3,200	36,759
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax	2	0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax	0	0
Fair Value	3,202	36,759
Yankee debt securities
Available-for-sale securities - short-term:
Amortized Cost	14,764	3,941
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax	0	0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax	0	(9)
Fair Value	$ 14,764	3,932
Supranational
Available-for-sale securities - short-term:
Amortized Cost		3,054
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax		0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax		(3)
Fair Value		3,051
Asset-backed securities
Available-for-sale securities - short-term:
Amortized Cost		12,128
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Gain, Current, Before Tax		0
Debt Securities, Available-For-Sale, Accumulated Gross Unrealized Loss, Current, Before Tax		(12)
Fair Value		12,116
Available-for-sale securities - long-term:
Amortized Cost		4,044
Gross Unrealized Gains		0
Gross Unrealized Losses		(4)
Fair Value		$ 4,040

Marketable Securities - Narrati

Marketable Securities - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Investments, Debt and Equity Securities [Abstract]
Marketable securities, short-term	$ 44,863	$ 76,702
Marketable securities, short-term, maturity	1 year	1 year
Marketable securities, long-term		$ 7,120
Marketable securities, long-term, maturity		2 years

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	12 Months Ended
Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 9,179	$ 6,779
Work in process	2,025	1,772
Finished goods	2,123	7,857
Total inventory	13,327	16,408
Inventory write-down	$ 3,800	$ 1,300

Lessor Sales-Type Leases - Narr

Lessor Sales-Type Leases - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Lessor, Lease, Description [Line Items]
Lease revenue	$ 0.3	$ 1.2
Sales-type Lease, Income, Comprehensive Income [Extensible List]	Revenue	Revenue
Prepaid Expenses and Other Current Assets
Lessor, Lease, Description [Line Items]
Lease receivable	$ 0.6	$ 0.9
Other Assets
Lessor, Lease, Description [Line Items]
Lease receivable	$ 0.5	$ 0.7

Lessor Sales-Type Leases - Esti

Lessor Sales-Type Leases - Estimated Future Maturities of Customer Sales-Type Lease Receivables (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Leases [Abstract]
Year ending December 31, 2023	$ 616
Year ending December 31, 2024	368
Year ending December 31, 2025	127
Total maturities of customer sales-type leases	$ 1,111

Property and Equipment, Net - S

Property and Equipment, Net - Summary of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 24,708	$ 25,572
Less: accumulated depreciation	(15,487)	(11,902)
Property and equipment, net	9,221	13,670
Medical diagnostic equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	14,826	16,759
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment	432	433
Office equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	1,556	1,538
Laboratory equipment and software
Property, Plant and Equipment [Line Items]
Total property and equipment	5,148	5,302
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment	580	582
Construction in process
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 2,166	$ 958

Property and Equipment, Net - N

Property and Equipment, Net - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Depreciation	$ 6,060	$ 5,754

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Summary of Goodwill and Intangible Assets (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Jun. 30, 2022
Goodwill
Balance at beginning of period	$ 12,026,000	$ 12,026,000
Goodwill impairment	(12,026,000)	0
Balance at end of period	0	12,026,000
Intangible Assets
Balance at beginning of period	5,013,000	5,653,000
Amortization expense	(420,000)	(640,000)
Intangible assets disposed in sale	(3,010,000)
Balance at end of period	1,583,000	$ 5,013,000
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Intangible Assets
Intangible assets sold	$ 3,000,000		$ 3,010,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Summary of Finite Lived Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Intangible Assets	$ 2,000	$ 6,300
Accumulated Amortization	(417)	(1,287)
Finite-Lived Intangible Assets, Net	$ 1,583	$ 5,013	$ 5,653
Developed technology
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)		10 years
Weighted Average Remaining Life (in years)		7 years 7 months 6 days
Intangible Assets		$ 4,200
Accumulated Amortization		(1,020)
Finite-Lived Intangible Assets, Net		$ 3,180
Customer-related intangible
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)		5 years
Weighted Average Remaining Life (in years)		2 years 6 months
Intangible Assets		$ 100
Accumulated Amortization		(50)
Finite-Lived Intangible Assets, Net		$ 50
Licensed intangibles
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)	10 years	10 years
Weighted Average Remaining Life (in years)	7 years 10 months 24 days	8 years 10 months 24 days
Intangible Assets	$ 2,000	$ 2,000
Accumulated Amortization	(417)	(217)
Finite-Lived Intangible Assets, Net	$ 1,583	$ 1,783

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Narrative (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill impairment	$ 12,026,000	$ 0
Amortization of intangible assets	420,000	640,000
Impairment of intangible assets	$ 0	$ 0

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Summary of Remaining Amortization Expense Associated with Amortizable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Year ending December 31, 2023	$ 200
Year ending December 31, 2024	200
Year ending December 31, 2025	200
Year ending December 31, 2026	200
Year ending December 31, 2027	200
Thereafter	583
Finite-Lived Intangible Assets, Net	1,583	$ 5,013	$ 5,653
Developed technology
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Net		3,180
Customer-related intangible
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Net		50
Licensed intangibles
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Net	$ 1,583	$ 1,783

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Compensation and related expenses	$ 6,919	$ 7,088
Professional fees	126	158
Deferred revenue	326	401
Sales and use tax	639	71
Clinical studies	390	541
Clinician Council payable	216	358
Accrued royalties	159	129
Accrued restructuring	45	0
Other	866	350
Total accrued liabilities	$ 9,686	$ 9,096

Debt - Summary of Outstanding D

Debt - Summary of Outstanding Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Jun. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Total outstanding debt under credit agreements	$ 36,776		$ 44,550
Less: Unamortized debt discount and fees	(2,342)		(4,135)
Total outstanding debt, long-term	34,434		40,415
2022 Amended Credit Agreement
Debt Instrument [Line Items]
Total outstanding debt under credit agreements	36,776		0
2022 Amended Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Debt instrument, fee amount	1,800	$ 1,800
2019 Credit Agreement
Debt Instrument [Line Items]
Total outstanding debt under credit agreements	0		$ 44,550
2019 Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Debt instrument, fee amount	$ 4,600

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands			12 Months Ended
	Jun. 30, 2022	May 20, 2019	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Class of warrants, exercise price (in dollars per share)			$ 2.56	$ 9.41	$ 9.10
Loss on extinguishment of debt			$ 7,947	$ 0
Exercise of common stock warrants
Debt Instrument [Line Items]
Class of warrants number of securities called by the warrants or rights (in shares)	3,779,018
Class of warrants, exercise price (in dollars per share)	$ 1.1114
Warrant, term	8 years
2019 Credit Agreement
Debt Instrument [Line Items]
Warrants liability fair value			$ 900
Class of warrants number of securities called by the warrants or rights (in shares)			419,992
2019 Credit Agreement \| Series C Convertible Preferred Stock
Debt Instrument [Line Items]
Class of warrants, exercise price (in dollars per share)			$ 16.67
2019 Credit Agreement \| Series D Convertible Preferred Stock
Debt Instrument [Line Items]
Class of warrants, exercise price (in dollars per share)			$ 16.67
2019 Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Conversion amount		$ 70,000
Proceeds from senior term loan		$ 40,000
Debt instrument, interest rate		7.75%
Debt instrument, fee amount			$ 4,600
2022 Amended Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Conversion amount	$ 35,000
Debt instrument, fee amount	$ 1,800		$ 1,800
Debt instrument, term	5 years
2022 Amended Credit Agreement \| Senior Term Loan \| Debt Instrument, Amortization Payment, Period One
Debt Instrument [Line Items]
Periodic payment, percentage of principal	15%
2022 Amended Credit Agreement \| Senior Term Loan \| Debt Instrument, Amortization Payment, Period Two
Debt Instrument [Line Items]
Periodic payment, percentage of principal	15%
2022 Amended Credit Agreement \| Senior Term Loan \| Debt Instrument, Amortization Payment, Period Three
Debt Instrument [Line Items]
Periodic payment, percentage of principal	70%
2022 Amended Credit Agreement \| Senior Term Loan \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	9%
Debt instrument, basis spread on variable rate, floor	2.50%

Operating Leases - Narrative (D

Operating Leases - Narrative (Details)	Dec. 31, 2022 ft²
Corporate Office Space and Manufacturing Facility
Lessee, Lease, Description [Line Items]
Office space	50,800
Operating lease, renewal term	5 years
Office Space Zaventem Belgium
Lessee, Lease, Description [Line Items]
Office space	3,900

Operating Leases - Summary of Q

Operating Leases - Summary of Quantitative Information About Operating Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Cash flows from operating leases	$ 898	$ 853
Operating Lease, Weighted Average Remaining Lease Term	4 years 10 months 24 days	3 years 7 months 6 days
Weighted average discount rate – operating leases	7%	7%

Operating Leases - Summary of C

Operating Leases - Summary of Components of Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Operating leases
Operating lease cost	$ 1,013	$ 950
Variable lease cost	293	325
Total operating lease expense	$ 1,306	$ 1,275

Operating Leases - Summary of F

Operating Leases - Summary of Future Minimum Payments Under the Non-Cancelable Operating Leases (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
Year ending December 31, 2023	$ 618
Year ending December 31, 2024	1,166
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Year ending December 31, 2027	1,221
Total future minimum operating lease payments	5,341
Less: imputed interest	(919)
Total operating lease liability	$ 4,422

Commitments and Contingencies (

Commitments and Contingencies (Details)	Dec. 31, 2022 lawsuit
Commitments and Contingencies Disclosure [Abstract]
Number of class action lawsuits	2

Warrants - Schedule of Outstand

Warrants - Schedule of Outstanding Warrants to Purchase the Company's Common Stock (Details) - $ / shares	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 2.56	$ 9.41	$ 9.10
Warrants outstanding (in shares)	4,576,505	797,487	824,608
Common Stock \| Warrants issued in 2015
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 5.25
Warrants outstanding (in shares)	3,808	3,808
Common Stock \| Warrants issued with 2018 Convertible Notes
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 0.10
Warrants outstanding (in shares)	346,689	346,689
Common Stock \| Warrants issued with 2018 Term Loan
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 16.67
Warrants outstanding (in shares)	26,998	26,998
Common Stock \| 2019 Warrants
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 16.67
Warrants outstanding (in shares)	419,992	419,992
Common Stock \| 2022 Warrants
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 1.11
Warrants outstanding (in shares)	3,779,018	0

Warrants - Schedule of Warrants

Warrants - Schedule of Warrants Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Warrants
Balance at beginning of period (in shares)	797,487	824,608
Exercised (in shares)		(26,958)
Shares withheld for exercise price (in shares)		(163)
Granted (in shares)	3,779,018
Balance at end of period (in shares)	4,576,505	797,487	824,608
Weighted Average Exercise Price
Balance at beginning of period (in dollars per share)	$ 9.41	$ 9.10
Exercised (in dollars per share)		0.10
Shares withheld for exercise price (in dollars per share)		0.10
Granted (in dollars per share)	1.11
Balance at end of period (in dollars per share)	$ 2.56	$ 9.41	$ 9.10
Weighted Average Remaining Contractual Life	7 years 2 months 12 days	5 years 10 months 24 days	7 years 10 months 24 days
Weighted Average Remaining Contractual Life, Exercised		6 years 2 months 12 days
Weighted Average Remaining Contractual Life, Shares withheld for exercise price		6 years 2 months 12 days
Weighted Average Remaining Contractual Life, Granted	7 years 6 months

Warrants - Narrative (Details)

Warrants - Narrative (Details)	12 Months Ended
Warrants - Narrative (Details)	Dec. 31, 2022 holder
Warrants and Rights Note Disclosure [Abstract]
Number of warrant holders	4
Maximum percentage of outstanding common stock	0.049
Maximum percentage of outstanding common stock, notice for increase	0.099

Stockholders_ Equity (Details)

Stockholders’ Equity (Details) $ / shares in Units, $ in Thousands	1 Months Ended		12 Months Ended
	Aug. 31, 2021 investor $ / shares shares	Jul. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares
Class of Stock [Line Items]
Number of shares issued during the period (in shares)		6,325,000
Proceeds from issuance of common stock, net of issuance costs \| $		$ 82,700	$ 0	$ 82,657
Stock option exercises (in shares)			35,478	111,804
Proceeds from the exercise of stock options \| $			$ 67	$ 711
Employee stock purchase plan shares issued \| $			$ 214	$ 440
Number of investors \| investor	4
Preferred stock, par value (in dollars per share) \| $ / shares			$ 0.001	$ 0.001
Maximum percentage of outstanding common stock			0.049
Common stock conversion, notice for increase, period			61 days
Maximum percentage of outstanding common stock, notice for increase			0.099
Common Stock
Class of Stock [Line Items]
Conversion of stock shares converted (in shares)	6,665,841
Series A Preferred Stock
Class of Stock [Line Items]
Conversion of stock, shares issued (in shares)	6,666
Preferred stock, par value (in dollars per share) \| $ / shares	$ 0.001
Conversion of stock, option to convert to common stock (in shares)			1,000
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Restricted stock issued during the period (in shares)			412,628	134,050
Restricted Stock Awards
Class of Stock [Line Items]
Restricted stock issued during the period (in shares)			0	186
Common Stock
Class of Stock [Line Items]
Number of shares issued during the period (in shares)				6,325,000
Stock option exercises (in shares)			35,478	111,804
Employee stock purchase plan shares issued (in shares)			149,327	33,641
Over-Allotment Option
Class of Stock [Line Items]
Number of shares issued during the period (in shares)		825,000
Price per share (in dollars per share) \| $ / shares		$ 14
Public Stock Offering
Class of Stock [Line Items]
Sale of stock, consideration received on transaction \| $		$ 88,600

Stock-Based Compensation - Narr

Stock-Based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands		12 Months Ended
	Jul. 25, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jul. 15, 2022	Aug. 05, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Expected dividend yield		0%	0%
Weighted average exercise price, options (in dollars per share)		$ 6.83	$ 13.12	$ 13.32	$ 9.75
Fair value exercise price to calculate aggregate intrinsic value of options (in dollars per share)		1.15	3.41	11.58
Share based compensation by share based payment arrangement weighted-average grant date fair value per share of stock option grants (in dollars per share)		$ 1.33	$ 8.46	$ 11.58
Unrecognized compensation related to stock options not vested		$ 6,600
Share based compensation non vested award period for recognition		1 year 6 months
Option, exercise price (in dollars per share)					$ 1.34
Total stock-based compensation		$ 9,391	$ 13,754
Restricted Stock Units (RSUs)
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based compensation non vested award period for recognition		1 year 7 months 6 days
Unrecognized compensation related to restricted stock not vested		$ 5,100
Stock Option [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Unrecognized compensation related to restricted stock not vested	$ 300
Total stock-based compensation	$ 300
2020 Equity Incentive Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		4,431,305
Share based payment arrangement number of shares available for issuance (in shares)		2,037,630
Share based compensation by share based payments arrangement, number of additional shares authorized (in shares)		1,118,288
2011 Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		1,319,968
Share based payment arrangement number of shares available for issuance (in shares)		0
Share-based compensation by share based payments arrangement, remain available for issuance (in shares)		0
Share based compensation by share based payment arrangement stock options vesting term		4 years
Share based compensation by share based payment arrangement stock options contractual term		10 years
2020 ESPP
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		258,042				645,105
Shares available for purchase (in shares)		462,137
2020 ESPP \| Maximum
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Participants purchase price of common stock		85%
Two Thousand Twenty Two Inducement Equity Incentive Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		6,000,000
Share based payment arrangement number of shares available for issuance (in shares)		5,928,500

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Estimate of the Fair Value of Stock Option (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	1.76%	0.76%
Risk-free interest rate, maximum	3.39%	1.39%
Expected dividend yield	0%	0%
Expected term		5 years 6 months
Expected volatility, minimum	75%	60%
Expected volatility, maximum	90%	75%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term	5 years 6 months
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term	6 years	7 years

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Number of Shares
Outstanding at beginning of period (in shares)	3,781,636	3,403,607
Options granted (in shares)	782,430	1,196,281
Options exercised (in shares)	(35,478)	(111,804)
Options forfeited (in shares)	(1,629,767)	(706,448)
Outstanding at end of period (in shares)	2,898,821	3,781,636	3,403,607
Options vested and expected to vest December 31, 2022 (in shares)	2,898,821
Options exercisable as of December 31, 2022 (in shares)	1,744,253
Weighted Average Exercise Price
Outstanding at beginning of period (in dollars per share)	$ 13.12	$ 13.32
Options granted (in dollars per share)	1.48	12.89
Options exercised (in dollars per share)	1.85	6.36
Options forfeited (in dollars per share)	11.14	14.76
Outstanding at end of period (in dollars per share)	6.83	$ 13.12	$ 13.32
Options vested and expected to vest December 31, 2022 (in dollars per share)	6.83
Options vested and exercisable as of December 31, 2021 (in dollars per share)	$ 8.53
Stock Options Activity, Additional Disclosures
Weighted average remaining contractual life, Outstanding	6 years 10 months 24 days	7 years 7 months 6 days	8 years 1 month 6 days
Weighted average remaining contractual life, Options vested and expected to vest December 31, 2022	6 years 10 months 24 days
Weighted average remaining contractual life, Options exercisable December 31, 2022	5 years 9 months 18 days
Aggregate intrinsic value, Outstanding	$ 79	$ 93	$ 52,866
Aggregate intrinsic value, Options exercised		$ 2,799
Aggregate intrinsic value, Options vested and expected to vest December 31, 2022	79
Aggregate intrinsic value, Options exercisable December 31, 2022	$ 0

Stock-Based Compensation - Sc_2

Stock-Based Compensation - Schedule of PSU and RSU Activity (Details) - Performance Based Restricted Stock Units - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Number of Shares
Unvested balance at beginning of period (in shares)	995,091	545,466
Granted (in shares)	1,863,156	718,567
Forfeited (in shares)	(690,059)	(117,430)
Vested (in shares)	(508,290)	(151,512)
Unvested balance at end of period (in shares)	1,659,898	995,091
Weighted Average Grant Price
Unvested balance at beginning of period (in dollars per share)	$ 13.47	$ 16.53
Granted (in dollars per share)	1.76	12.25
Forfeited (in dollars per share)	6.71	17.22
Vested (in dollars per share)	10.11	15.77
Unvested balance at end of period (in dollars per share)	$ 4.17	$ 13.47

Stock-Based Compensation - Sc_3

Stock-Based Compensation - Schedule of RSA Activity (Details) - Restricted Stock Awards	12 Months Ended
	Dec. 31, 2021 $ / shares shares
Number of Shares
Unvested balance at beginning of period (in shares) \| shares	0
Granted (in shares) \| shares	186
Vested (in shares) \| shares	(186)
Unvested balance at end of period (in shares) \| shares	0
Weighted Average Grant Price
Unvested balance at beginning of period (in dollars per share) \| $ / shares	$ 0
Granted (in dollars per share) \| $ / shares	14.75
Vested (in dollars per share) \| $ / shares	14.75
Unvested balance at end of period (in dollars per share) \| $ / shares	$ 0

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Stock-Based Compensation Expense for the Stock Options, PSUs, RSAs, and ESPP Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 9,391	$ 13,754
Cost of products sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	669	864
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	1,736	2,181
Selling, general and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 6,986	$ 10,709

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details) - shares	12 Months Ended
Net Loss Per Common Share (Details) - shares	Dec. 31, 2022	Dec. 31, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	14,698,227	12,240,055
Conversion of Series A Common Equivalent Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	6,665,841	6,665,841
Exercise of common stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	4,576,505	797,487
Exercise of stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	1,744,253	3,781,636
Vesting of RSUs and RSAs
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	1,659,898	995,091
Issuance of shares under 2020 ESPP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	51,730	0

401(k) Retirement Plan (Details

401(k) Retirement Plan (Details) - USD ($)	12 Months Ended
401(k) Retirement Plan (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
401(k) Retirement Plan
Defined Contribution Plan Disclosure [Line Items]
Employer contribution to defined benefit plan	$ 0	$ 0

Income Taxes - Schedule of Comp

Income Taxes - Schedule of Components of Pretax Loss From Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
U.S.	$ (39,346)	$ (117,868)
Foreign	(188)	185
Loss before income taxes	$ (39,534)	$ (117,683)

Income Taxes - Schedule of Co_2

Income Taxes - Schedule of Components of Income Tax Expense for Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Federal	$ 0	$ 0
State	15	0
Foreign	67	0
Total provision for income taxes	$ 82	$ 0

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($)	12 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Taxes [Line Items]
Provision for state income taxes	$ 15,000	$ 0
Valuation allowance	110,907,000	106,717,000
Unrecognized tax benefits	4,795,000	4,128,000	$ 3,397,000
Unrecognized tax benefits that, if recognized, would affect the effective tax rate	4,400,000
Interest and/or penalties recognized	0	0
Interest and penalties accrued	0	$ 0
Capitalization of research and development expenses	$ 25,300,000
Federal
Income Taxes [Line Items]
Tax years remain open for examination, statute of limitation term	3 years
Maximum
Income Taxes [Line Items]
Provision for state income taxes	$ 100,000

Income Taxes - Schedule of Reco

Income Taxes - Schedule of Reconciliation of Expected Tax Computed at U.S. Statutory Federal Income Tax Rate to Total Expense for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income tax benefit at federal statutory rate	$ (8,302)	$ (24,714)
Adjustments for tax effects of:
State taxes, net	(847)	(2,343)
Permanent adjustments	917	352
Goodwill impairment	2,525	0
Stock based compensation expense	2,525	0
Research and development credit	(2,099)	(2,255)
Unrecognized tax benefit	630	676
Rate change	0	532
Return to provision	534	0
Other	0	817
Valuation allowance	4,199	26,935
Income tax expense	$ 82	$ 0
Income tax benefit at federal statutory rate	21%	21%
Adjustments for tax effects of:
State taxes, net	2.10%	2%
Permanent adjustments	(2.30%)	(0.30%)
Goodwill impairment	(6.40%)	0%
Stock based compensation expense	(6.40%)	0%
Research and development credit	5.30%	1.90%
Unrecognized tax benefit	(1.60%)	(0.60%)
Rate change	0%	(0.50%)
Return to provision	(1.30%)	0%
Other	0%	(0.60%)
Valuation allowance	(10.60%)	(22.90%)
Income tax expense	(0.20%)	0%

Income Taxes - Schedule of Co_3

Income Taxes - Schedule of Components of Company's Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Deferred tax assets:
Net operating losses	$ 94,437	$ 93,668
Stock-based compensation	1,678	2,468
Research and development credit	10,273	8,803
Capitalized research costs	9,473	0
Accrued compensation	1,161	432
Accrued expenses	0	446
Intangible assets	92	3,564
Lease liability	1,019	1,114
Inventory	655	202
Other	35	11
Total gross deferred tax assets	118,823	110,708
Valuation allowance	(110,907)	(106,717)
Net deferred tax asset	7,916	3,991
Deferred tax liabilities:
Deferred installment gain	(5,315)	0
Property and equipment	(1,105)	(1,986)
Right of use assets	(891)	(1,009)
Prepaid expenses	(105)	(593)
Other	(461)	(313)
Debt	(39)	(90)
Total deferred tax liabilities	(7,916)	(3,991)
Net deferred tax assets (liabilities)	$ 0	$ 0

Income Taxes - Schedule of NOLs

Income Taxes - Schedule of NOLs and Tax Credit Carryforwards (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Operating Loss Carryforwards [Line Items]
NOLs carried forward to offset taxable income for 2022 and thereafter	80%
Federal \| NOL, Indefinite Expiration
Operating Loss Carryforwards [Line Items]
NOL carryforwards	$ 309,325
Federal \| NOL, Expire in 2031
Operating Loss Carryforwards [Line Items]
NOL carryforwards	108,165
Federal \| NOL, Expire in 2031 \| R&D Credit Carryforwards
Operating Loss Carryforwards [Line Items]
Tax credit carryforwards	$ 9,503
Federal \| Earliest Tax Year
Operating Loss Carryforwards [Line Items]
NOL, expiration date	2031
Tax credit carryforward, expiration date	2031
Federal \| Latest Tax Year
Operating Loss Carryforwards [Line Items]
NOL, expiration date	2037
Tax credit carryforward, expiration date	2042
State \| NOL, Indefinite Expiration
Operating Loss Carryforwards [Line Items]
NOL carryforwards	$ 14,725
State \| NOL, Indefinite Expiration \| R&D Credit Carryforwards \| California
Operating Loss Carryforwards [Line Items]
Tax credit carryforwards	6,548
State \| NOL, Expire in 2026
Operating Loss Carryforwards [Line Items]
NOL carryforwards	$ 96,361
State \| Earliest Tax Year
Operating Loss Carryforwards [Line Items]
NOL, expiration date	2026
State \| Latest Tax Year
Operating Loss Carryforwards [Line Items]
NOL, expiration date	2042

Income Taxes - Schedule of Chan

Income Taxes - Schedule of Changes to Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at beginning of year	$ 4,128	$ 3,397
Gross increases – tax positions in current period	683	731
Gross decreases – tax positions in prior period	(16)	0
Balance at end of year	$ 4,795	$ 4,128

Related Party Transactions (Det

Related Party Transactions (Details) - USD ($) $ / shares in Units, $ in Millions		1 Months Ended	12 Months Ended
	Jun. 30, 2022	Aug. 31, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	May 20, 2019
Related Party Transaction [Line Items]
Preferred stock, par value (in dollars per share)			$ 0.001	$ 0.001
Common stock, shares issued (in shares)			28,554,656	27,957,223
Exercise price (in dollars per share)			$ 2.56	$ 9.41	$ 9.10
Exercise of common stock warrants
Related Party Transaction [Line Items]
Common stock, shares issued (in shares)	3,779,018
Exercise price (in dollars per share)	$ 1.1114
Warrant, term	8 years
Common Stock
Related Party Transaction [Line Items]
Conversion of stock shares converted (in shares)		6,665,841
Series A Preferred Stock
Related Party Transaction [Line Items]
Conversion of stock, shares issued (in shares)		6,666
Preferred stock, par value (in dollars per share)		$ 0.001
2019 Credit Agreement
Related Party Transaction [Line Items]
Line of credit cumulative drawdowns till date	$ 40		$ 34.4	$ 40.4
2019 Credit Agreement \| Senior Term Loan
Related Party Transaction [Line Items]
Conversion amount						$ 70
2022 Amended Credit Agreement \| Senior Term Loan
Related Party Transaction [Line Items]
Conversion amount	$ 35
Director and the Chairman \| Consulting Agreement \| Selling, general and administrative
Related Party Transaction [Line Items]
Consulting fees incurred for related party			0.2	0.1
Director and the Chairman \| IPO \| Selling, general and administrative \| PSUs
Related Party Transaction [Line Items]
Consulting fees incurred for related party				4.6
Orbimed Royalty Oppurtunities Two LP and Deerfield Private Design Fund LP \| 2019 Credit Agreement
Related Party Transaction [Line Items]
Interest expenses related party			$ 5.1	$ 5.7