0001628280-22-007921 | 10-K | XBRL Viewer

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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, 2021	Dec. 31, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 13,754	$ 12,103
Cost of products sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	864	440
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	2,181	1,002
Selling, general and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 10,709	$ 10,661

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment, Net

The Company’s property and equipment, net, consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021		December 31, 2020
Medical diagnostic equipment	$	16,759	$	13,242
Furniture and fixtures	433		388
Office equipment	1,538		1,392
Laboratory equipment and software	5,302		3,491
Leasehold improvements	582		608
Construction in process	958		468
Total property and equipment	25,572		19,589
Less: accumulated depreciation	(11,902)		(7,233)
Property and equipment, net	$	13,670	$	12,356

Asset Acquisition and Business Combination	12 Months Ended
Asset Acquisition and Business Combination	Dec. 31, 2021
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”) to obtain certain licenses to the Biotronik Parties’ patents, whereby the Company acquired certain manufacturing equipment and obtained from the Biotronik Parties a license under certain patents and technology to develop, commercialize, distribute and manufacture the AcQBlate FORCE ablation catheters and Qubic Force Device. In exchange for the rights granted to the Company, the Company made cash payments totaling $10.0 million during the year ended December 31, 2019, and issued 273,070 shares of Series D convertible preferred stock with an implied value of $5.0 million during the three months ended March 31, 2020. The implied value of $5.0 million was recorded as an accrued liability as of December 31, 2019. 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. On the acquisition date, the products licensed had not yet received regulatory approval and the intellectual property did not have an alternative use. Accordingly, the $15.0 million paid to Biotronik was immediately charged to research and development expense - licensed acquired in the consolidated statement of operations and comprehensive loss in July 2019. Additional contingent milestone payments of up to $10.0 million, of which $2.0 million has been paid as of December 31, 2021, are to be made to the Biotronik Parties contingent upon certain regulatory approvals and first commercial sale. 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 Company also makes per unit royalty payments. As of December 31, 2021, less than $0.1 million has been included within accrued liabilities for these royalties. The Company determined that the remaining $8.0 million of contingent milestones are not probable and estimable and therefore have not been recorded as a liability as of December 31, 2021 and December 31, 2020. Upon regulatory approval in December 2020 of the Company’s force sensing ablation catheter in Europe, the $2.0 million milestone was capitalized and is being amortized, and the royalty payments are recorded as cost of products sold as sales of catheters are recognized. Rhythm Xience Business Combination On June 18, 2019 (the “Acquisition Date”), 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 cash payment did not include the potential $17.0 million in earn out consideration, of which $2.2 million was paid with the issuance of Series D convertible preferred stock in February 2020 and the remainder is to be paid based on the achievement of certain regulatory milestones and revenue milestones. In accordance with ASC 805, the Rhythm Xience Acquisition was accounted for as a business combination. As part of the Rhythm Xience Acquisition, the Company recorded a contingent consideration liability for potential additional payments due to the sellers of Rhythm Xience if certain regulatory approval milestones and revenue milestones are achieved. The initial contingent consideration liability of $13.4 million was based on the fair value of the contingent consideration liability at the Acquisition Date. During the year ended December 31, 2020, the Company issued 119,993 shares of Series D convertible preferred stock and paid $2.5 million of the contingent consideration for the achievement of certain regulatory and revenue milestones. During the year ended December 31, 2021, the Company paid an additional $3.4 million of the contingent consideration for the achievement of certain regulatory and revenue milestones. Additionally, the Company recorded a $3.7 million decrease and $0.1 million increase for the years ended December 31, 2021 and 2020, respectively, which is included in change in fair value of contingent consideration in the consolidated statements of operations and comprehensive loss. As of December 31, 2021, the contingent consideration liability of $2.0 million is the fair value of the remaining payments due to the sellers of Rhythm Xience if certain revenue milestones are achieved. For the years ended December 31, 2021 and 2020, no acquisition costs were incurred or recorded.

Consolidated Statements of Convertible Preferred Stock and Stockholders’ Equity (Deficit) (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement of Stockholders' Equity [Abstract]
Issuance costs	$ 5,893	$ 16,361

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

The components of pretax loss from operations for the years ended December 31, 2021 and 2020 are as follows:


	December 31,
	2021		2020
U.S. domestic	$	(117,868)	$	(102,048)
Foreign	185		90
Pretax loss from operations	$	(117,683)	$	(101,958)

The components of income tax expense for continuing operations are as follows:


	December 31,
	2021		2020
Current tax provision:
Federal	$	—	$	—
State	—		23
Foreign	—		—
Total provision for income taxes	$	—	$	23

There was no provision for state incomes taxes for the year ended December 31, 2021. The provision for state income taxes was less than $0.1 million for the year ended December 31, 2020. Current income taxes are based upon the year’s income taxable for federal, state and foreign tax reporting purposes. Deferred income taxes (benefits) 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.

A reconciliation of the expected tax computed at the U.S. statutory federal income tax rate to the total expense for income taxes for the years ended December 31, 2021 and 2020 is as follows (dollars in thousands):


	Year Ended December 31,
	2021				2020
Income tax benefit at federal statutory rate	$	(24,714)	21.00	%	$	(21,411)	21.00	%
Adjustments for tax effects of:
State taxes, net	(2,343)		2.00	%	(2,237)		2.19	%
Permanent adjustments	352		(0.30)	%	968		(0.95)	%

Warrants	—		—	%	1,167		(1.14)	%
Research and development credit	(2,255)		1.90	%	(5,870)		5.76	%
Unrecognized tax benefit	676		(0.60)	%	1,761		(1.73)	%
Valuation allowance	26,935		(22.90)	%	26,619		(26.11)	%
Rate change	532		(0.50)	%	(737)		0.72	%
Other	817		(0.60)	%	(237)		0.23	%
Income tax expense	$	—	—	%	$	23	(0.03)	%

Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2021 and 2020 were as follows (in thousands):


	December 31,
	2021		2020
Deferred tax assets:
Net operating losses	$	93,668	$	68,727
Stock-based compensation	2,468		1,225
Research and development credit	8,803		7,225
Accrued vacation	432		390
Accrued expenses	446		745

Inventory	202		—
Intangible assets	3,564		3,863
Lease liability	1,114		439
Other	11		196
Total gross deferred tax assets	110,708		82,810
Valuation allowance	(106,717)		(79,782)
Net deferred tax asset	3,991		3,028
Deferred tax liabilities:
Property and equipment	(1,986)		(1,979)
Prepaid expenses	(593)		(642)
Right of use assets	(1,009)		(349)
IRC 263A	—		(58)
Other deferred tax liabilities	(313)		—
Debt	(90)		—
Total deferred tax liabilities	(3,991)		(3,028)
Net deferred tax assets (liabilities)	$	—	$	—

In assessing the realizability of deferred tax assets as of December 31, 2021 and 2020, 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 has determined it is more likely than not that its net deferred tax assets will not be realized. Accordingly, a valuation allowance has been recorded as of December 31, 2021 and 2020, to fully offset the net deferred tax assets of $106.7 million and $79.8 million, respectively.

As of December 31, 2021, the Company had approximately $415.3 million of NOL carryforwards available for federal tax purposes. As a result of the Tax Cuts and Jobs Act, for U.S. income tax purposes, NOLs generated prior to December 31, 2017 can still be carried forward for up to 20 years, but NOLs generated after December 31, 2017 carryforward indefinitely, but are limited to 80% utilization against taxable income. Of the total federal NOL of $415.3 million, $108.2 million will begin to expire in 2031 and $307.1 million will not expire but will only offset 80% of future taxable income.

On December 27, 2020, the United States enacted the Consolidated Appropriations Act of 2021 (“CAA”). The CAA includes provisions extending certain CARES Act provisions and adds coronavirus relief and tax and health extenders.

As of December 31, 2021, the Company also had approximately $105.7 million of state NOL carryforwards. The state NOLs begin to expire in 2029.

As of December 31, 2021, the Company had no NOL carryforwards available for foreign tax purposes.

As of December 31, 2021, the Company had approximately $8.1 million of R&D credit carryforwards available for federal tax purposes, which begin to expire in 2031. As of December 31, 2021, the Company also had approximately $5.6 million of R&D credit carryforwards for California. The state R&D credits do not expire.

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.

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, 2021 and 2020 (in thousands):


	December 31,
	2021		2020
Balance at beginning of year	$	3,397	$	1,539
Increases related to prior year tax positions	—		1,210
Increases related to current year tax positions	731		648
Balance at end of year	$	4,128	$	3,397

As of December 31, 2021, the Company has unrecognized tax benefits of $4.1 million of which $3.8 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, 2021 and 2020.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

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+ Details

Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Instruments [Abstract]

Summary of Outstanding Debt

Outstanding debt as of December 31, 2021 and 2020 consisted of the following (in thousands):


	December 31, 2021		December 31, 2020
2019 Credit Agreement (1)	$	44,550	$	44,550
Total debt, gross	44,550		44,550
Less: Unamortized debt discount and fees	(4,135)		(5,539)
Total long-term debt	$	40,415	$	39,011

(1)The 2019 Credit Agreement includes final payment fees of $4.6 million.

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

Operating Leases - Narrative (Details)	Dec. 31, 2021 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 lease, renewal term	3 years

Debt - Narrative (Details) - USD ($)		12 Months Ended
Debt - Narrative (Details) - USD ($)	May 20, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Class of warrants, exercise price (in dollars per share)		$ 9.41	$ 9.10	$ 7.88
2019 Credit Agreement
Debt Instrument [Line Items]
Debt instrument, interest rate		7.75%
Debt instrument, fee amount		$ 4,600,000	$ 4,600,000
Warrants liability fair value		$ 900,000
Class of warrants number of securities called by the warrants or rights (in shares)		419,992
Debt instrument, direct fees		$ 1,200,000
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	$ 16.67
2019 Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Conversion amount	$ 70,000,000
Proceeds from senior term loan	40,000,000
Debt instrument, remaining amount	30,000,000
Debt instrument unused borrowing capacity	$ 0
Debt instrument, fee amount		$ 4,600,000
Debt instrument, Initial debt discount before inception		$ 6,700,000
Default Event \| Senior Term Loan
Debt Instrument [Line Items]
Debt instrument, interest rate, increase (decrease)		10.00%

Organization and Description of Business	12 Months Ended
Organization and Description of Business	Dec. 31, 2021
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, transseptal crossing tools, 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, 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, 2021 and 2020, the Company had cash, cash equivalents and marketable securities of $107.9 million and $139.8 million, respectively. For the years ended December 31, 2021 and 2020, net losses were $117.7 million and $102.0 million, respectively, and net cash used in operating activities was $99.7 million and $85.2 million respectively. As of December 31, 2021 and 2020, the Company had an accumulated deficit of $478.7 million and $361.0 million, respectively, and working capital of $107.8 million and $129.5 million, respectively. Prior to the Company’s initial public offering (“IPO”) in August 2020, operations had been financed primarily by aggregate net proceeds from the sale of convertible preferred stock and principal of converted debt of $253.9 million, as well as other indebtedness. On August 10, 2020, the Company issued 10,147,058 shares of common stock in its IPO, which included 1,323,529 shares of common stock issued upon the exercise in full by the underwriters of an option to purchase additional shares of common stock, at the public offering price less underwriting discounts and commissions. The price to the public was $18.00 per share, for net proceeds of $166.3 million. 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 from the offering. With the closing of the Company’s IPO in August 2020, the follow on offering in July 2021 and the January 2022 reduction in force, management believes the Company’s current cash, cash equivalents and marketable securities are sufficient to fund operations for at least the next 12 months. Under Accounting Standard Codification (“ASC”) Subtopic 205-40, Presentation of Financial Statements—Going Concern (“ASC 205-40”), the Company has the responsibility to evaluate whether conditions and/or events raise substantial doubt about its ability to meet its future financial obligations as they become due within one year after the date that the consolidated financial statements are issued. As required under ASC 205-40, management’s evaluation should initially not take into consideration the potential mitigating effects of management’s plans that have not been fully implemented as of the date the consolidated financial statements are issued. The accompanying consolidated financial statements have been prepared assuming that the Company will continue as a going concern. Substantial Doubt Raised In performing the first step of the evaluation, the Company concluded that the following conditions raised substantial doubt about its ability to continue as a going concern: •History of net losses of $117.7 million and $102.0 million for the years ended December 31, 2021 and December 31, 2020, respectively; •Accumulated deficit of $478.7 million and $361.0 million as of December 31, 2021 and December 31, 2020, respectively; •Disruptions in elective procedure volumes related to unanticipated impacts from COVID-19; and •History of negative gross margins. Consideration of Management’s Plans In performing the second step of this assessment, the Company is required to evaluate whether it is probable that its plans will be effectively implemented within one year after the consolidated financial statements are issued and whether it is probable those plans will alleviate the substantial doubt about its ability to continue as a going concern. The Company has identified several potential actions to strengthen liquidity and optimize resources in the event actual results and other planned activities differ materially from projections. The Company is prepared to rapidly implement these actions as required by business and market conditions. These actions would improve the available cash balances, liquidity and cash flows generated from operations over the twelve-month period from the date the consolidated financial statements are issued, as follows: •Reduction in force that would be intended to extend the cash runway necessary to fund operations; •Total compensation reductions for senior executives to strengthen liquidity and to preserve key research and development, commercial and functional roles; •Identification of efficiencies within corporate functions to reduce certain external consulting and business support spend; and •Deferral and reprioritization of certain research and development programs that would involve reduced program and headcount spend. Management Assessment of Ability to Continue as a Going Concern The Company has a history of operating losses and negative cash flows from operations. However, despite these conditions, the Company believes management’s plans, as described more fully above, will provide sufficient liquidity to meet its financial obligations and maintain levels of liquidity as specifically required under the 2019 Credit Agreement, as defined below. Therefore, management concluded these plans alleviate the substantial doubt that was raised about the Company’s ability to continue as a going concern for at least twelve months from the date that the consolidated financial statements were issued. Future Plans and Considerations Although not considered for purposes of the Company’s assessment of whether substantial doubt was alleviated, the Company has retained several specialized third-party consultants and advisors to review its strategy as well as a range of options to fund the long-term growth of the Company, including non-dilutive financing, partnerships, licensing, and distribution agreements. The Company’s plans are subject to inherent risks and uncertainties, which become significantly magnified when the effects of the current pandemic and related financial crisis are included in the assessment. Accordingly, there can be no assurance that the Company’s plans can be effectively implemented and, therefore, that the conditions can be effectively mitigated. The Company may need to raise additional funds through the issuance of debt and/or equity securities or otherwise. Until such time, if ever, that the Company can generate revenue sufficient to achieve profitability, the Company expects to finance its operations through equity or debt financings, which may not be available to the Company on the timing needed or on terms that the Company deems to be favorable. To the extent that the Company raises additional capital through the sale of equity or convertible debt securities, the ownership interest of its stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect the rights of common stockholders. Debt financing and preferred equity financing, if available, may involve agreements that include covenants limiting or restricting the Company’s ability to take specific actions, such as incurring additional debt, making acquisitions or capital expenditures or declaring dividends. If the Company is unable to maintain sufficient financial resources, its business, financial condition and results of operations will be materially and adversely affected. The Company may be required to delay, limit, reduce or terminate its product discovery and development activities or future commercialization efforts.

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Reclassification of warrant liability to additional paid-in capital	$ 0	$ 14,474
Significant Unobservable Inputs (Level 3)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at beginning of period	9,300	22,819
Payment of contingent consideration	(3,435)	(2,500)
Issuance of preferred stock for contingent consideration		(2,197)
Reclassification of warrant liability to additional paid-in capital		(14,474)
Escrow release	(119)
Change in fair value of contingent consideration	(3,746)	5,652
Balance at end of period	2,000	9,300
Common and Preferred Stock 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	8,919
Payment of contingent consideration	0
Reclassification of warrant liability to additional paid-in capital		(14,474)
Escrow release	0
Change in fair value of contingent consideration	0	5,555
Balance at end of period	0	0
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	9,300	13,900
Payment of contingent consideration	(3,435)	(2,500)
Issuance of preferred stock for contingent consideration		(2,197)
Reclassification of warrant liability to additional paid-in capital		0
Escrow release	(119)
Change in fair value of contingent consideration	(3,746)	97
Balance at end of period	$ 2,000	$ 9,300

Net Loss Per Common Share (Details) - shares	12 Months Ended
Net Loss Per Common Share (Details) - shares	Dec. 31, 2021	Dec. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	12,240,055	4,773,681
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	0
Exercise of stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	3,781,636	3,403,607
Exercise of common stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	797,487	824,608
Vesting of PSUs and RSUs
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	995,091	545,466

Accrued Liabilities (Tables)

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Summary of Accrued Liabilities

Accrued liabilities consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021		December 31, 2020
Compensation and related expenses	$	7,088	$	6,250
Professional fees	158		120
Deferred revenue	401		301
Sales and use tax	71		169
Clinical studies	541		187
Clinician accounts	358		149
Accrued royalties	129		86
Other	350		46
Total accrued liabilities	$	9,096	$	7,308

Summary of Significant Accounting Policies - Summary of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 17,263	$ 8,464
Disposables
Summary of Significant Accounting Policies [Line Items]
Total revenue	11,938	6,713
Systems
Summary of Significant Accounting Policies [Line Items]
Total revenue	4,058	1,660
Service/Other
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 1,267	$ 91

- Definition

Amount, including tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value-added and excise.

+ References

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+ Details

Income Taxes - Schedule of Components of Pretax Loss From Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
U.S. domestic	$ (117,868)	$ (102,048)
Foreign	185	90
Loss before income taxes	$ (117,683)	$ (101,958)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Marketable Securities - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Securities, Available-for-sale [Line Items]
Available-for-sale securities	$ 83,822	$ 114,565
Short-term debt
Debt Securities, Available-for-sale [Line Items]
Available-for-sale securities	$ 76,702	$ 105,839
Debt securities, available-for-sale, maturity	1 year	1 year
Long-term debt
Debt Securities, Available-for-sale [Line Items]
Available-for-sale securities	$ 7,120	$ 8,700
Debt securities, available-for-sale, maturity	2 years
Long-term debt \| Minimum
Debt Securities, Available-for-sale [Line Items]
Debt securities, available-for-sale, maturity		2 years
Long-term debt \| Maximum
Debt Securities, Available-for-sale [Line Items]
Debt securities, available-for-sale, maturity		4 years

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

The tables below summarize goodwill and intangible assets activities as of December 31, 2021 and 2020 (in thousands):


	Goodwill		Intangible Assets
Balance, December 31, 2019	$	12,026	$	4,110
Biotronik license agreement	—		2,000
Amortization expense	—		(457)
Balance, December 31, 2020	12,026		5,653

Amortization expense	—		(640)
Balance, December 31, 2021	$	12,026	$	5,013


	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		December 31, 2021
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			$	6,300	$	(1,287)	$	5,013


	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		December 31, 2020
Developed technology	10	8.6	$	4,200	$	(600)	$	3,600
Customer-related intangible	5	3.5	100		(30)		70
Licensed intangibles	10	9.9	2,000		(17)		1,983
Total			$	6,300	$	(647)	$	5,653

Acquired in-process technology was classified as an indefinite-lived intangible asset until the receipt of FDA approval for the technology in January 2020. Once FDA approval was received, the in-process technology was reclassified as developed technology and amortization began. The Company recorded amortization expense related to the above intangible assets of $0.6 million and $0.5 million for the years ended December 31, 2021 and 2020, respectively.

The following table shows the remaining amortization expense associated with amortizable intangible assets as of December 31, 2021 (in thousands):


	Developed Technology		Customer- Related Intangible		Licensed Intangibles		Total Amortization
Year ending December 31, 2022	$	420	$	20	$	200	$	640
Year ending December 31, 2023	420		20		200		640
Year ending December 31, 2024	420		10		200		630
Year ending December 31, 2025	420		—		200		620
Year ending December 31, 2026	420		—		200		620
Thereafter	1,080		—		783		1,863
Total	$	3,180	$	50	$	1,783	$	5,013

Operating Leases - Summary of Quantitative Information About Operating Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating cash flows from operating leases	$ 853	$ 1,013
Weighted average remaining lease term – operating leases (in years)	3 years 7 months 6 days	1 year 7 months 6 days
Weighted average discount rate – operating leases	7.00%	7.00%

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 24,071	$ 25,234
Marketable securities, short-term	76,702	105,839
Restricted cash	150	150
Accounts receivable	3,633	2,160
Inventory	16,408	12,958
Prepaid expenses and other current assets	5,326	5,047
Total current assets	126,290	151,388
Marketable securities, long-term	7,120	8,726
Property and equipment, net	13,670	12,356
Right-of-use asset, net	4,521	1,669
Intangible assets, net	5,013	5,653
Goodwill	12,026	12,026
Other assets	1,152	717
Total assets	169,792	192,535
Current liabilities:
Accounts payable	7,519	8,266
Accrued liabilities	9,096	7,308
Contingent consideration, short-term	1,500	5,400
Operating lease liabilities, short-term	395	933
Total current liabilities	18,510	21,907
Operating lease liabilities, long-term	4,591	1,134
Long-term debt	40,415	39,011
Contingent consideration, long-term	500	3,900
Other long-term liabilities	50	0
Total liabilities	64,066	65,952
Commitments and contingencies (Note 12)
Stockholders' equity
Preferred stock, $0.001 par value; 5,000,000 shares authorized December 31, 2021 and 2020; 6,666 shares of preferred stock, designated as Series A Common Equivalent Preferred Stock, are issued and outstanding as of December 31, 2021, no shares issued and outstanding as of December 31, 2020	0	0
Common stock, $0.001 par value; 260,000,000 shares authorized as of December 31, 2021 and 2020; 27,957,223 and 27,991,425 shares issued and outstanding as of December 31, 2021 and 2020, respectively	28	28
Additional paid-in capital	584,613	487,290
Accumulated deficit	(478,698)	(361,015)
Accumulated other comprehensive (loss) income	(217)	280
Total stockholders' equity	105,726	126,583
Total liabilities and stockholders' equity	$ 169,792	$ 192,535

Net Loss Per Common Share

12 Months Ended

Dec. 31, 2021

Earnings Per Share [Abstract]

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, PSUs, RSUs and warrants because their effect would be anti-dilutive due to the Company’s net loss. Since the Company had a net 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,
Shares issuable upon:	2021	2020




Conversion of Series A Common Equivalent Preferred Stock	6,665,841	—
Exercise of stock options	3,781,636	3,403,607
Exercise of common stock warrants	797,487	824,608

Vesting of PSUs and RSUs	995,091	545,466
Total	12,240,055	4,773,681

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

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, 2021		December 31, 2020
Cash and cash equivalents	$	24,071	$	25,234
Restricted cash	150		150
Total cash, cash equivalents and restricted cash	$	24,221	$	25,384

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, 2021		December 31, 2020
Cash and cash equivalents	$	24,071	$	25,234
Restricted cash	150		150
Total cash, cash equivalents and restricted cash	$	24,221	$	25,384

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, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020

Disposables	$	11,938	$	6,713
Systems	4,058		1,660
Service/Other	1,267		91
Total revenue	$	17,263	$	8,464

Summary of Revenue from External Customers by Geographic Areas

The following table provides revenue by geographic location for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020

United States	$	8,325	$	4,854
Outside the United States	8,938		3,610
Total revenue	$	17,263	$	8,464

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, 2021 and 2020 (in thousands):


	Fair Value Measured as of December 31, 2021
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Fair Value at December 31, 2021
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


	Fair Value Measured as of December 31, 2020
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Fair Value at December 31, 2020
Assets included in:
Cash and cash equivalents
Money market securities	$	19,070	$	—	$	—	$	19,070
Marketable securities at fair value
Corporate debt securities	—		31,353		—		31,353
Asset-backed securities	—		8,726		—		8,726
U.S. treasury securities	—		20,531		—		20,531
Commercial paper	—		53,955		—		53,955
Total fair value	$	19,070	$	114,565	$	—	$	133,635

Liabilities included in:
Contingent consideration	$	—	$	—	$	9,300	$	9,300
Total fair value	$	—	$	—	$	9,300	$	9,300

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, 2021 and 2020 (in thousands):


	Common and Preferred Stock Warrant Liability		Contingent Consideration		Total
Balance, December 31, 2019	$	8,919	$	13,900	$	22,819
Payment of contingent consideration	—		(2,500)		(2,500)
Issuance of preferred stock for contingent consideration	—		(2,197)		(2,197)
Reclassification of warrant liability to additional paid-in capital	(14,474)		—		(14,474)
Change in fair value	5,555		97		5,652
Balance, December 31, 2020	$	—	$	9,300	$	9,300
Payment of contingent consideration	—		(3,435)		(3,435)
Escrow release	—		(119)		(119)
Change in fair value	—		(3,746)		(3,746)
Balance, December 31, 2021	$	—	$	2,000	$	2,000

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, 2021 and December 31, 2020 were as follows:


	December 31, 2021	December 31, 2020
Risk-free interest rate	0.60%	0.20%
Expected term in years	1.0 - 2.0	1.0 - 2.0
Expected volatility	28.8%	17.2%

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
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	0
Preferred stock, shares outstanding (in shares)	6,666	0
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)	27,957,223	27,991,425
Common stock, shares outstanding (in shares)	27,957,223	27,991,425

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, 2021	Dec. 31, 2020
Risk-free interest rate
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, Fair value inputs	0.0060	0.0020
Expected term in years \| Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, Fair value inputs	1.0	1.0
Expected term in years \| Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, Fair value inputs	2.0	2.0
Expected volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, Fair value inputs	0.288	0.172

Convertible Preferred Stock - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions		1 Months Ended	12 Months Ended
	Aug. 10, 2020	Feb. 29, 2020	Dec. 31, 2021
Firm Underwritten Commitment \| Prospective Event Triggering Conversion of Temporary Equity into Permanent Equity
Temporary Equity [Line Items]
Stock issue share price (in dollars per share)			$ 50.00
Firm Underwritten Commitment \| Prospective Event Triggering Conversion of Temporary Equity into Permanent Equity \| Minimum
Temporary Equity [Line Items]
Sale of stock consideration received			$ 50.0
Series A Convertible Preferred Stock
Temporary Equity [Line Items]
Conversion of stock shares converted (in shares)	391,210
Series B Convertible Preferred Stock
Temporary Equity [Line Items]
Conversion of stock shares converted (in shares)	3,088,444
Series C Convertible Preferred Stock
Temporary Equity [Line Items]
Conversion of stock shares converted (in shares)	4,499,921
Series D Convertible Preferred Stock
Temporary Equity [Line Items]
Conversion of stock shares converted (in shares)	8,593,360
Series A convertible preferred stock \| Non Cumulative Dividends
Temporary Equity [Line Items]
Temporary equity dividend per share declared (in dollars per share)			$ 0.68
Series B convertible preferred stock \| Non Cumulative Dividends
Temporary Equity [Line Items]
Temporary equity dividend per share declared (in dollars per share)			1.07
Series C convertible preferred stock \| Non Cumulative Dividends
Temporary Equity [Line Items]
Temporary equity dividend per share declared (in dollars per share)			$ 1.36
Rhythm Xcience Acquisition \| Series D convertible preferred stock
Temporary Equity [Line Items]
Business combination contingent consideration shares issued value		$ 2.2
Biotonik Asset Acquisition \| Series D convertible preferred stock
Temporary Equity [Line Items]
Business combination contingent consideration shares issued value		$ 5.0
Business combination contingent consideration shares issued shares (in shares)		273,070
Rhythm Xience \| Series D convertible preferred stock
Temporary Equity [Line Items]
Business consideration, number of equity interests issued and issuable (in shares)		119,993

Operating Leases - Summary of Future Minimum Payments Under the Non-Cancelable Operating Leases (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
Year ending December 31, 2022	$ 903
Year ending December 31, 2023	1,135
Year ending December 31, 2024	1,167
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Thereafter	1,221
Total	6,762
Less: present value discount	(1,776)
Operating lease liabilities	$ 4,986

Property and Equipment, Net - Summary of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 25,572	$ 19,589
Less: accumulated depreciation	(11,902)	(7,233)
Property and equipment, net	13,670	12,356
Medical diagnostic equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	16,759	13,242
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment	433	388
Office equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	1,538	1,392
Laboratory equipment and software
Property, Plant and Equipment [Line Items]
Total property and equipment	5,302	3,491
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment	582	608
Construction in process
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 958	$ 468

Goodwill and Intangible Assets - Summary of Finite Lived Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Intangible Assets	$ 6,300	$ 6,300
Accumulated Amortization	(1,287)	(647)
Finite-Lived Intangible Assets, Net	$ 5,013	$ 5,653	$ 4,110
Developed technology
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)	10 years	10 years
Weighted Average Remaining Life (in years)	7 years 7 months 6 days	8 years 7 months 6 days
Intangible Assets	$ 4,200	$ 4,200
Accumulated Amortization	(1,020)	(600)
Finite-Lived Intangible Assets, Net	$ 3,180	$ 3,600
Customer-related intangible
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)	5 years	5 years
Weighted Average Remaining Life (in years)	2 years 6 months	3 years 6 months
Intangible Assets	$ 100	$ 100
Accumulated Amortization	(50)	(30)
Finite-Lived Intangible Assets, Net	$ 50	$ 70
Licensed intangibles
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life (in years)	10 years	10 years
Weighted Average Remaining Life (in years)	8 years 10 months 24 days	9 years 10 months 24 days
Intangible Assets	$ 2,000	$ 2,000
Accumulated Amortization	(217)	(17)
Finite-Lived Intangible Assets, Net	$ 1,783	$ 1,983

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement of Comprehensive Income [Abstract]
Revenue	$ 17,263	$ 8,464
Costs and operating expenses:
Cost of products sold	32,925	15,889
Research and development	36,683	33,454
Selling, general and administrative	63,523	50,357
Change in fair value of contingent consideration	(3,746)	97
Total costs and operating expenses	129,385	99,797
Loss from operations	(112,122)	(91,333)
Other income (expense):
Change in fair value of warrant liability	0	(5,555)
Interest income	116	436
Interest expense	(5,677)	(5,506)
Total other expense, net	(5,561)	(10,625)
Loss before income taxes	(117,683)	(101,958)
Income tax expense	0	23
Net loss	(117,683)	(101,981)
Other comprehensive income (loss):
Unrealized loss on marketable securities	(37)	(53)
Foreign currency translation adjustment	(460)	363
Comprehensive loss	$ (118,180)	$ (101,671)
Net loss per common share, basic (in dollars per share)	$ (4.11)	$ (8.94)
Net loss per common share, diluted (in dollars per share)	$ (4.11)	$ (8.94)
Weighted average shares outstanding, basic (in shares)	28,654,313	11,407,542
Weighted average shares outstanding, diluted (in shares)	28,654,313	11,407,542

Debt - Summary of Outstanding Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total debt, gross	$ 44,550	$ 44,550
Less: Unamortized debt discount and fees	(4,135)	(5,539)
Total long-term debt	40,415	39,011
2019 Credit Agreement
Debt Instrument [Line Items]
Total debt, gross	44,550	44,550
Debt instrument, fee amount	$ 4,600	$ 4,600

Convertible Preferred Stock

12 Months Ended

Dec. 31, 2021

Temporary Equity [Abstract]

Convertible Preferred Stock

On August 10, 2020, in connection with the closing of the IPO, all of the 391,210 shares of Series A, 3,088,444 shares of Series B, 4,499,921 shares of Series C and 8,593,360 shares of Series D convertible preferred stock automatically converted into an equal number of shares of common stock.

In February 2020, the Company issued 119,993 shares of its Series D convertible preferred stock with an implied value of $2.2 million in connection with a contingent consideration payment related to the Rhythm Xience Acquisition.

In February 2020, the Company issued 273,070 shares of its Series D convertible preferred stock with an implied value of $5.0 million for the final purchase consideration of the Biotronik Asset Acquisition.

Redemption

The convertible preferred stock was not unconditionally redeemable at the option of the holder thereof. However, the convertible preferred stock was contingently redeemable upon certain liquidation events. As redemption by the holders was not solely within the control of the Company, all of the outstanding convertible preferred stock was classified as temporary equity in the consolidated balance sheets, prior to the conversion to common stock on August 10, 2020.

Dividends

The holders of shares of convertible preferred stock were entitled to receive dividends, out of any assets legally available therefore, prior and in preference to any declaration or payment of any dividend on the common stock of the Company, at the

applicable dividend rate, payable on a pro rata, pari passu basis when, as and if declared by the Company’s board of directors. The dividend rate was $0.68 per annum for each share of Series A convertible preferred stock, $1.07 per annum for each share of Series B convertible preferred stock and $1.36 per annum for each share of Series C convertible preferred stock and Series D convertible preferred stock, as adjusted. The dividend rights were not cumulative.

Liquidation

The holders of the Series D convertible preferred stock were entitled to receive a liquidation preference prior to any distribution to the holders of Series A convertible preferred stock, Series B convertible preferred stock and Series C convertible preferred stock (collectively the “Junior Preferred Stock”) and the holders of common stock, in the amount of the original issue price plus declared but unpaid dividends on such shares (the “Series D Liquidation Preference”). The holders of the Junior Preferred Stock were entitled to receive a liquidation preference prior to any distribution to the holders of common stock, after payment of the Series D Liquidation Preference, in the amount of the applicable original issue price plus declared but unpaid dividends on such shares.

Voting Rights

Holders of convertible preferred stock had the right to one vote for each share of common stock into which such preferred stock could then be converted, and with respect to such vote, such holder had full voting rights and powers equal to the voting rights and powers of the holders of common stock.

As long as any shares of Series D convertible preferred stock were outstanding, the holders of such shares of Series D convertible preferred stock (voting exclusively as a separate series) were entitled to elect one director. As long as any shares of Series C convertible preferred stock were outstanding, the holders of such shares of Series C convertible preferred stock (voting exclusively as a separate series) were entitled to elect three directors. As long as any shares of Series A convertible preferred stock or Series B convertible preferred stock were outstanding, the holders of such shares (voting together as a single class and not as separate series, and on an as converted basis) were entitled to elect four directors. The holders of outstanding common stock were entitled to elect one director. The holders of convertible preferred stock and common stock (voting together as a single class and not as separate series, and on an as-converted basis) were entitled to elect any remaining directors.

Conversion

Each share of preferred stock was convertible, at the option of the holder thereof, at any time after the date of issuance of such share, into such number of fully paid and nonassessable shares of the Company’s common stock as was determined by dividing the original issue price, as adjusted, for such series by the applicable conversion price for such series in effect on the date the certificate is surrendered for conversion. The initial conversion price per share for each series of convertible preferred stock was the original issue price applicable to such series as follows:


Series	Conversion Price
Series A convertible preferred stock	$	8.295
Series B convertible preferred stock	$	13.370
Series C convertible preferred stock	$	16.667
Series D convertible preferred stock	$	16.667

Each share of convertible preferred stock was automatically converted into fully-paid, non-assessable shares of common stock at the conversion rate at the time in effect for such series of preferred stock immediately upon: (i) the date, or the occurrence of an event, specified by vote or written consent or agreement of the requisite investors; or (ii) the closing of the sale of shares of common stock to the public, at a price of at least $50.00 per share, as adjusted, in a firm-commitment underwritten public offering pursuant to an effective registration statement under the Securities Act of 1933, as amended, resulting in at least $50.0 million of net proceeds to the Company. As noted above, on August 10, 2020, all shares of Series A, Series B, Series C and Series D convertible preferred stock were converted into common stock.

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets included in:
Available-for-sale securities	$ 83,822	$ 114,565
Total fair value	105,715	133,635
Liabilities included in:
Total fair value	2,000	9,300
Contingent consideration
Liabilities included in:
Total fair value	2,000	9,300
Money market securities
Assets included in:
Money market securities	21,893	19,070
Corporate debt securities
Assets included in:
Available-for-sale securities	18,860	31,353
U.S. treasury securities
Assets included in:
Available-for-sale securities	5,064	20,531
Commercial paper
Assets included in:
Available-for-sale securities	36,759	53,955
Yankee debt securities
Assets included in:
Available-for-sale securities	3,932
Supranational
Assets included in:
Available-for-sale securities	3,051
Asset-backed securities
Assets included in:
Available-for-sale securities	16,156	8,726
Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets included in:
Total fair value	21,893	19,070
Liabilities included in:
Total fair value	0	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	21,893	19,070
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Corporate debt securities
Assets included in:
Available-for-sale securities	0	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
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	0
Significant Other Observable Inputs (Level 2)
Assets included in:
Total fair value	83,822	114,565
Liabilities included in:
Total fair value	0	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	31,353
Significant Other Observable Inputs (Level 2) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	5,064	20,531
Significant Other Observable Inputs (Level 2) \| Commercial paper
Assets included in:
Available-for-sale securities	36,759	53,955
Significant Other Observable Inputs (Level 2) \| Yankee debt securities
Assets included in:
Available-for-sale securities	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	8,726
Significant Unobservable Inputs (Level 3)
Assets included in:
Total fair value	0	0
Liabilities included in:
Total fair value	2,000	9,300
Significant Unobservable Inputs (Level 3) \| Contingent consideration
Liabilities included in:
Total fair value	2,000	9,300
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	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
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	$ 0

Stockholders’ Equity (Details) $ / shares in Units, $ in Thousands		1 Months Ended		12 Months Ended
	Aug. 10, 2020 USD ($) $ / shares shares	Aug. 31, 2021 investor $ / shares shares	Jul. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2020 USD ($) $ / shares shares
Class of Stock [Line Items]
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
Number of shares issued during the period (in shares)			6,325,000
Proceeds from issuance of common stock \| $			$ 82,700
Proceeds from issuance of common stock, net of issuance costs \| $				$ 82,657	$ 166,286
Common stock, shares authorized (in shares)	260,000,000			260,000,000	260,000,000
Convertible preferred stock, shares authorized (in shares)	5,000,000
Stock option exercises (in shares)				111,804	172,312
Proceeds from stock options exercises \| $				$ 711	$ 634
Employee stock purchase plan shares issued \| $				$ 440
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Number of shares, vested (in shares)				134,050	285,369
Restricted Stock Awards
Class of Stock [Line Items]
Number of shares, vested (in shares)				186	34,051
Amended and Restated Certificate of Incorporation
Class of Stock [Line Items]
Proceeds from stock options exercises \| $					$ 600
Common Stock
Class of Stock [Line Items]
Number of shares issued during the period (in shares)				6,325,000
Stock option exercises (in shares)				111,804	124,938
Employee stock purchase plan shares issued (in shares)				33,641	0
Over-Allotment Option
Class of Stock [Line Items]
Number of shares issued during the period (in shares)	1,323,529		825,000
Price per share (in dollars per share) \| $ / shares			$ 14.00
Public Stock Offering
Class of Stock [Line Items]
Sale of stock, consideration received on transaction \| $			$ 88,600
IPO
Class of Stock [Line Items]
Number of shares issued during the period (in shares)	10,147,058
Price per share (in dollars per share) \| $ / shares	$ 18.00
Gross proceeds from IPO \| $	$ 182,600
Proceeds from issuance of common stock, net of issuance costs \| $	$ 166,300
IPO and Over Allotment
Class of Stock [Line Items]
Price per share (in dollars per share) \| $ / shares	$ 18.00
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

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

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, 2021 and 2020 are as follows:


	December 31,
	2021		2020
U.S. domestic	$	(117,868)	$	(102,048)
Foreign	185		90
Pretax loss from operations	$	(117,683)	$	(101,958)

Schedule of Components of Income Tax Expense for Continuing Operations

The components of income tax expense for continuing operations are as follows:


	December 31,
	2021		2020
Current tax provision:
Federal	$	—	$	—
State	—		23
Foreign	—		—
Total provision for income taxes	$	—	$	23

Schedule of Reconciliation of Expected Tax Computed at U.S. Statutory Federal Income Tax Rate to Total Expense for Income Taxes


	Year Ended December 31,
	2021				2020
Income tax benefit at federal statutory rate	$	(24,714)	21.00	%	$	(21,411)	21.00	%
Adjustments for tax effects of:
State taxes, net	(2,343)		2.00	%	(2,237)		2.19	%
Permanent adjustments	352		(0.30)	%	968		(0.95)	%

Warrants	—		—	%	1,167		(1.14)	%
Research and development credit	(2,255)		1.90	%	(5,870)		5.76	%
Unrecognized tax benefit	676		(0.60)	%	1,761		(1.73)	%
Valuation allowance	26,935		(22.90)	%	26,619		(26.11)	%
Rate change	532		(0.50)	%	(737)		0.72	%
Other	817		(0.60)	%	(237)		0.23	%
Income tax expense	$	—	—	%	$	23	(0.03)	%

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, 2021 and 2020 were as follows (in thousands):


	December 31,
	2021		2020
Deferred tax assets:
Net operating losses	$	93,668	$	68,727
Stock-based compensation	2,468		1,225
Research and development credit	8,803		7,225
Accrued vacation	432		390
Accrued expenses	446		745

Inventory	202		—
Intangible assets	3,564		3,863
Lease liability	1,114		439
Other	11		196
Total gross deferred tax assets	110,708		82,810
Valuation allowance	(106,717)		(79,782)
Net deferred tax asset	3,991		3,028
Deferred tax liabilities:
Property and equipment	(1,986)		(1,979)
Prepaid expenses	(593)		(642)
Right of use assets	(1,009)		(349)
IRC 263A	—		(58)
Other deferred tax liabilities	(313)		—
Debt	(90)		—
Total deferred tax liabilities	(3,991)		(3,028)
Net deferred tax assets (liabilities)	$	—	$	—

Schedule of Changes to Unrecognized Tax Benefits

The following table summarizes the changes to unrecognized tax benefits as of December 31, 2021 and 2020 (in thousands):


	December 31,
	2021		2020
Balance at beginning of year	$	3,397	$	1,539
Increases related to prior year tax positions	—		1,210
Increases related to current year tax positions	731		648
Balance at end of year	$	4,128	$	3,397

Marketable Securities

12 Months Ended

Dec. 31, 2021

Investments, Debt and Equity Securities [Abstract]

Marketable Securities

Marketable securities consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
Corporate debt securities, short-term	$	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, short-term	12,128		—		(12)		12,116
Total available-for-sale securities - short-term	76,741		—		(39)		76,702

Corporate debt securities, long-term	3,082		—		(2)		3,080
Asset-backed securities, long-term	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


	December 31, 2020
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
Corporate debt securities	$	31,359	$	—	$	(6)	$	31,353
U.S. treasury securities	20,533		—		(2)		20,531
Commercial paper	53,955		—		—		53,955
Total available-for-sale securities - short-term	105,847		—		(8)		105,839

Asset-backed securities, long-term	8,726		—		—		8,726
Total available-for-sale securities	$	114,573	$	—	$	(8)	$	114,565

As of December 31, 2021, the Company’s available-for-sale securities classified as short-term of $76.7 million mature in one year or less and the available-for-sale securities classified as long-term of $7.1 million mature within two years. As of December 31, 2020, the Company’s available-for-sale securities classified as short-term of $105.8 million mature in one year or less and the available-for-sale securities classified as long-term of $8.7 million mature within two to four years.

Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 6,779	$ 7,960
Work in process	1,772	1,267
Finished goods	7,857	3,731
Total inventory	$ 16,408	$ 12,958

Property and Equipment, Net - Narrative (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Depreciation	$ 5,754,000	$ 2,763,000
Impairment of property and equipment	$ 0	$ 0

Income Taxes - Schedule of Components of Company's Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Net operating losses	$ 93,668	$ 68,727
Stock-based compensation	2,468	1,225
Research and development credit	8,803	7,225
Accrued vacation	432	390
Accrued expenses	446	745
Inventory	202	0
Intangible assets	3,564	3,863
Lease liability	1,114	439
Other	11	196
Total gross deferred tax assets	110,708	82,810
Valuation allowance	(106,717)	(79,782)
Net deferred tax asset	3,991	3,028
Deferred tax liabilities:
Property and equipment	(1,986)	(1,979)
Prepaid expenses	(593)	(642)
Right of use assets	(1,009)	(349)
IRC 263A	0	(58)
Other deferred tax liabilities	(313)	0
Debt	(90)	0
Total deferred tax liabilities	(3,991)	(3,028)
Net deferred tax assets (liabilities)	$ 0	$ 0

Debt

12 Months Ended

Dec. 31, 2021

Debt Instruments [Abstract]

Debt

Outstanding debt as of December 31, 2021 and 2020 consisted of the following (in thousands):


	December 31, 2021		December 31, 2020
2019 Credit Agreement (1)	$	44,550	$	44,550
Total debt, gross	44,550		44,550
Less: Unamortized debt discount and fees	(4,135)		(5,539)
Total long-term debt	$	40,415	$	39,011

(1)The 2019 Credit Agreement includes final payment fees of $4.6 million.

2019 Credit Agreement

On May 20, 2019, the Company entered into a credit agreement (the “2019 Credit Agreement”). The 2019 Credit Agreement 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. Of the remaining $30.0 million, none is available for borrowing. The 2019 Credit Agreement bears interest per annum at 7.75% plus LIBOR for such interest period and the principal amount of term loans outstanding under the 2019 Credit Agreement is due on May 20, 2024. The 2019 Credit Agreement provides for final payment fees of an additional $4.6 million that are due upon prepayment or on the maturity date or upon acceleration.

Upon the occurrence and during an event of default, which includes but is not limited to payment default, covenant default or the occurrence of a material adverse change, the lenders may declare all outstanding principal and accrued and unpaid interest immediately due and payable, there would be an increase in the applicable interest rate by 10% per annum, and the lenders would be entitled to exercise their other rights and remedies provided for under the 2019 Credit Agreement. Additionally, the lenders may request repayment of a portion of obligations outstanding under the 2019 Credit Agreement to the extent of the Company’s receipt of any (i) net casualty proceeds or (ii) net asset sales proceeds, as defined. These acceleration and early payment features are an embedded derivative that is separately measured from the loan host instrument and classified with the loan host instrument.

In connection with the issuance of the 2019 Credit Agreement, the Company issued liability-classified 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 then were automatically converted into warrants to purchase an equal number of shares of common stock at $16.67 per share. The initial recognition of the warrant liability and direct fees of $1.2 million and final payment fees of $4.6 million for the 2019 Credit Agreement resulted in a discount of $6.7 million, which is being amortized to interest expense over the term of the 2019 Credit Agreement using the effective interest method.

The Company’s obligations under the 2019 Credit Agreement are secured by substantially all of its assets, including its intellectual property, and is guaranteed by Acutus NV. The 2019 Credit Agreement contains customary affirmative and negative covenants, including with respect to the Company’s ability to enter into fundamental transactions, incur additional indebtedness, grant liens, pay any dividend or make any distributions to its holders, make investments and merge or consolidate with any other person or engage in transactions with its affiliates, but does not include any financial covenants, other than a minimum liquidity requirement. As of and for the years ended December 31, 2021 and 2020, the Company was in compliance with all such covenants.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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-Name Accounting Standards Codification
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+ Details

Warrants - Schedule of Warrants Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Warrants
Balance at beginning of period (in shares)	824,608	956,552
Exercised (in shares)	(26,958)	(131,944)
Shares withheld for exercise price (in shares)	(163)
Balance at end of period (in shares)	797,487	824,608	956,552
Weighted Average Exercise Price
Balance at beginning of period (in dollars per share)	$ 9.10	$ 7.88
Exercised (in dollars per share)	0.10	0.25
Shares withheld for exercise price (in dollars per share)	0.10
Balance at end of period (in dollars per share)	$ 9.41	$ 9.10	$ 7.88
Weighted Average Remaining Contractual Life	6 years 10 months 24 days	7 years 10 months 24 days	8 years 9 months 18 days
Weighted Average Remaining Contractual Life, Exercised	6 years 4 months 24 days	7 years 6 months
Weighted Average Remaining Contractual Life, Shares withheld for exercise price	6 years 4 months 24 days

Stock-Based Compensation - Schedule of PSU and RSU Activity (Details) - Performance Based Restricted Stock Units - $ / shares	1 Months Ended	12 Months Ended
	Jun. 30, 2019	Dec. 31, 2021	Dec. 31, 2020
Number of Shares
Unvested balance at beginning of period (in shares)		545,466	567,509
Granted (in shares)	567,509	718,567	270,718
Forfeited (in shares)		(117,430)	(7,386)
Vested (in shares)		(151,512)	(285,375)
Unvested balance at end of period (in shares)		995,091	545,466
Weighted Average Grant Price
Unvested balance at beginning of period (in dollars per share)		$ 16.53	$ 13.37
Granted (in dollars per share)	$ 13.37	12.25	19.87
Forfeited (in dollars per share)		17.22	18.00
Vested (in dollars per share)		15.77	13.37
Unvested balance at end of period (in dollars per share)		$ 13.47	$ 16.53

Summary of Significant Accounting Policies - Summary of Cash and Restricted Cash (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Cash and cash equivalents	$ 24,071	$ 25,234
Restricted cash	150	150
Total cash, cash equivalents and restricted cash	$ 24,221	$ 25,384	$ 9,602

Lessor Sales-Type Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Estimated Future Maturities of Customer Sales-Type Lease Receivables

As of December 31, 2021, estimated future maturities of customer sales-type lease receivables for each of the following years were as follows (in thousands):


Year ending December 31, 2022	$	859
Year ending December 31, 2023	408
Year ending December 31, 2024	244
Year ending December 31, 2025	71
Year ending December 31, 2026	—
Lease receivable	$	1,582

401(k) Retirement Plan	12 Months Ended
401(k) Retirement Plan	Dec. 31, 2021
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 did not provide any contributions to the 401(k) retirement savings plan for the years ended December 31, 2021 and 2020.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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+ Details

Summary of Significant Accounting Policies - Narrative (Details)	12 Months Ended
	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)
Summary of Significant Accounting Policies [Line Items]
Number of operating segment \| segment	1
Other-than-temporary impairments related to marketable securities	$ 0	$ 0
Cash, FDIC insured amount	250,000
Inventory write-down	1,300,000	100,000
Allowance for uncollectible accounts	0	0
Impairment of property and equipment	$ 0	$ 0
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
Property and equipment, estimated useful lives	5 years
Deferred Equipment Agreements
Summary of Significant Accounting Policies [Line Items]
Up front charge	$ 0
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 Accounting Policies - Summary of Revenue from External Customers by Geographic Areas (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 17,263	$ 8,464
United States
Summary of Significant Accounting Policies [Line Items]
Total revenue	8,325	4,854
Outside the United States
Summary of Significant Accounting Policies [Line Items]
Total revenue	$ 8,938	$ 3,610

- Definition

+ References

+ Details

Asset Acquisition and Business Combination - Narrative (Details) - USD ($)		1 Months Ended		3 Months Ended	12 Months Ended
	Jun. 18, 2019	Feb. 29, 2020	Jul. 31, 2019	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Research and development					$ 36,683,000	$ 33,454,000
Payments for contingent consideration					3,435,000	2,500,000
Change in fair value of contingent consideration					(3,746,000)	97,000
Acquisition costs					0	0
Biotronik Asset Acquisition
Business Acquisition [Line Items]
Consideration paid in cash							$ 10,000,000
Equity interests issued and issuable							$ 5,000,000
Payments for contingent consideration					2,000,000
Accrued liabilities					(100,000)
Contingent milestone and royalty payments					8,000,000	8,000,000
Potential milestone payments capitalized						2,000,000
Biotronik Asset Acquisition \| Maximum
Business Acquisition [Line Items]
Potential milestone payments payable					10,000,000
Biotronik Asset Acquisition \| Intellectual Property
Business Acquisition [Line Items]
Consideration transferred			$ 15,000,000
Research and development			$ 15,000,000
Biotronik Asset Acquisition \| Series D Convertible Preferred Stocks
Business Acquisition [Line Items]
Business consideration, number of equity interests issued and issuable (in shares)				273,070
Equity interests issued and issuable				$ 5,000,000
Rhythm Xience
Business Acquisition [Line Items]
Consideration paid in cash	$ 3,000,000
Payments for contingent consideration					3,400,000	2,500,000
Contingent consideration liability	13,400,000				2,000,000
Change in fair value of contingent consideration					$ (3,700,000)	$ 100,000
Rhythm Xience \| Earnout Consideration
Business Acquisition [Line Items]
Potential milestone payments payable	$ 17,000,000
Rhythm Xience \| Series D Convertible Preferred Stocks
Business Acquisition [Line Items]
Business consideration, number of equity interests issued and issuable (in shares)						119,993
Rhythm Xience \| Series D Convertible Preferred Stocks \| Earnout Consideration
Business Acquisition [Line Items]
Equity interests issued and issuable		$ 2,200,000

Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2021

Investments, Debt and Equity Securities [Abstract]

Summary of Marketable Securities

Marketable securities consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
Corporate debt securities, short-term	$	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, short-term	12,128		—		(12)		12,116
Total available-for-sale securities - short-term	76,741		—		(39)		76,702

Corporate debt securities, long-term	3,082		—		(2)		3,080
Asset-backed securities, long-term	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


	December 31, 2020
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
Corporate debt securities	$	31,359	$	—	$	(6)	$	31,353
U.S. treasury securities	20,533		—		(2)		20,531
Commercial paper	53,955		—		—		53,955
Total available-for-sale securities - short-term	105,847		—		(8)		105,839

Asset-backed securities, long-term	8,726		—		—		8,726
Total available-for-sale securities	$	114,573	$	—	$	(8)	$	114,565

Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2021

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, 2021 and 2020:


	Year Ended December 31,
	2021	2020
Risk-free interest rate	0.76% - 1.39%	0.35% - 0.90%
Expected dividend yield	—	—
Expected term in years	5.5 - 7	7
Expected volatility	60% - 75%	60% - 80%

Summary of Stock Option Activity

The following table summarizes stock option activity during the years ended December 31, 2021 and 2020:


	Stock Options	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2019	2,041,205	$	9.52	7.7	$	10,782
Options granted	1,794,895	16.91
Options exercised	(172,312)	7.52			$	1,660
Options forfeited	(260,181)	12.10
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	3,781,636	$	13.12	7.6	$	93
Options vested and exercisable as of December 31, 2021	1,799,522	$	11.74	6.1	$	64

Schedule of PSU and RSA Activity

The Company’s PSU and RSU activity for the years ended December 31, 2021 and 2020 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2019	567,509	$	13.37
Granted	270,718	19.87
Forfeited	(7,386)	18.00
Vested	(285,375)	13.37
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

Schedule of RSA Activity

The Company’s RSA activity for the years ended December 31, 2021 and 2020 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2019	—	$	—
Granted	34,051	16.85
Vested	(34,051)	16.85
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, PSUs, RSUs, RSAs and ESPP expense recorded in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020
Cost of products sold	$	864	$	440
Research and development	2,181		1,002
Selling, general and administrative	10,709		10,661
Total stock-based compensation	$	13,754	$	12,103

Operating Leases - Summary of Components of Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating leases
Operating lease cost	$ 950	$ 864
Variable lease cost	325	311
Total rent expense	$ 1,275	$ 1,175

Stock-Based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended	12 Months Ended
	Jun. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Aug. 05, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Shares issued, share-based payment arrangement, forfeited (in shares)		300,092
Expected dividend yield		0.00%	0.00%
Fair value exercise price to calculate aggregate intrinsic value of options (in dollars per share)		$ 3.41	$ 28.81
Share based compensation by share based payment arrangement weighted-average grant date fair value per share of stock option grants (in dollars per share)		$ 8.46	$ 11.58
Unrecognized compensation related to stock options not vested		$ 26.6
Share based compensation non vested award period for recognition		2 years 7 months 6 days
Performance Based Restricted Stock Units
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based compensation by share based payment arrangement instruments other than options granted (in shares)	567,509	718,567	270,718
Share based compensation by share based payment arrangement instruments other than options granted weighted average grant date fair value (in dollars per share)	$ 13.37	$ 12.25	$ 19.87
2020 Equity Incentive Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		3,313,017
Share based payment arrangement number of shares available for issuance (in shares)		1,077,978
2011 Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		2,258,659
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)				387,063
2020 ESPP \| Maximum
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Participants purchase price of common stock		85.00%

Consolidated Statements of Convertible Preferred Stock and Stockholders’ Equity (Deficit) - USD ($) $ in Thousands	Total	Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)	Series A Convertible Preferred Stock	Series B Convertible Preferred Stock	Series C Convertible Preferred Stock	Series D Convertible Preferred Stock
Balance at beginning of period (in shares) at Dec. 31, 2019							391,210	3,088,444	4,499,921	8,200,297
Balance at beginning of period at Dec. 31, 2019							$ 3,059	$ 40,685	$ 74,575	$ 135,039
Increase (Decrease) in Temporary Equity [Roll Forward]
Issuance of Series D convertible preferred stock for the Biotronik Asset Purchase (in shares)										273,070
Issuance of Series D convertible preferred stock for the Biotronik Asset Purchase										$ 5,000
Issuance of Series D convertible preferred stock for the contingent consideration related to the Rhythm Xience Acquisition (in shares)										119,993
Issuance of Series D convertible preferred stock for the contingent consideration related to the Rhythm Xience Acquisition										$ 2,197
Conversion of convertible preferred stock into common stop upon IPO (in shares)							(391,210)	(3,088,444)	(4,499,921)	(8,593,360)
Conversion of convertible preferred stock into common stock upon IPO							$ (3,059)	$ (40,685)	$ (74,575)	$ (142,236)
Balance at end of period (in shares) at Dec. 31, 2020							0	0	0	0
Balance at end of period at Dec. 31, 2020							$ 0	$ 0	$ 0	$ 0
Balance at beginning of period (in shares) at Dec. 31, 2019			695,902
Balance at beginning of period at Dec. 31, 2019	$ (225,811)		$ 1	$ 33,252	$ (259,034)	$ (30)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized loss on marketable securities	(53)					(53)
Foreign currency translation adjustment	363					363
Exchange of common stock for Series A Common Equivalent Preferred Stock (in shares)			16,572,935
Exchange of common stock for Series A Common Equivalent Preferred Stock	260,555		$ 17	260,538
Issuance of common stock for cash, net of issuance cost of $16,361 (in shares)			10,147,058
Issuance of common stock for cash, net of issuance costs of $16,361	166,286		$ 10	166,276
Reclassification of warrant liability to stockholders' equity	$ 14,474			14,474
Stock option exercises (in shares)	172,312		124,938
Stock option exercises	$ 634			634
Stock-based compensation (in shares)			319,420
Stock-based compensation	12,103			12,103
Employee stock purchase plan shares issued (in shares)			0
Warrant exercises (in shares)			131,172
Warrant exercises	13			13
Net loss	(101,981)				(101,981)
Balance at end of period (in shares) at Dec. 31, 2020		0	27,991,425
Balance at end of period at Dec. 31, 2020	126,583	$ 0	$ 28	487,290	(361,015)	280
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized loss on marketable securities	(37)					(37)
Foreign currency translation adjustment	(460)					(460)
Exchange of common stock for Series A Common Equivalent Preferred Stock (in shares)		6,666	(6,665,841)
Exchange of common stock for Series A Common Equivalent Preferred Stock	0		$ (6)	6
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
Warrant exercises (in shares)			26,958
Warrant exercises	0
Net loss	(117,683)				(117,683)
Balance at end of period (in shares) at Dec. 31, 2021		6,666	27,957,223
Balance at end of period at Dec. 31, 2021	$ 105,726	$ 0	$ 28	$ 584,613	$ (478,698)	$ (217)

Accrued Liabilities

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Accrued Liabilities

Accrued liabilities consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021		December 31, 2020
Compensation and related expenses	$	7,088	$	6,250
Professional fees	158		120
Deferred revenue	401		301
Sales and use tax	71		169
Clinical studies	541		187
Clinician accounts	358		149
Accrued royalties	129		86
Other	350		46
Total accrued liabilities	$	9,096	$	7,308

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2021
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions In August 2021, the Company entered into the Exchange Agreements with 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). The Company licenses certain patent rights from a former director and shareholder. The license agreement provides for royalty payments to the shareholder of 3% of net product sales, as defined in the agreement. Royalties earned prior to the director’s resignation were less than $0.1 million for the year ended December 31, 2020. Additionally, the former director and shareholder also works for one of the Company’s customers and can significantly influence the customer to purchase the Company’s product. Prior to the director’s resignation, the Company recorded sales to this customer of $0.5 million for the year ended December 31, 2020. The Company has a consulting agreement with the chairman of the Company’s board of directors. The Company recorded $0.1 million and $0.2 million for the years ended December 31, 2021 and 2020, respectively, in SG&A expense in the consolidated statements of operations and comprehensive loss, for the consulting services. With the completion of the IPO, the performance condition was satisfied 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 for these awards for the year ended December 31, 2020 in SG&A expense in the consolidated statement of operations and comprehensive loss. Multiple preferred stock shareholders entered into the 2018 Convertible Notes and 2019 Convertible Notes that also contained detached warrants. Additionally, OrbiMed Royalty Opportunities II, LP and Deerfield Private Design Fund II, L.P. entered into the 2019 Credit Agreement with the Company in 2019 for a total of $70.0 million with $40.0 million being drawn as of December 31, 2021 and 2020. The Company recorded $5.7 million and $5.5 million for the years ended December 31, 2021 and 2020, respectively, in interest expense related to this debt agreement.

Organization and Description of Business (Details) - USD ($) $ / shares in Units, $ in Thousands		1 Months Ended	12 Months Ended
	Aug. 10, 2020	Jul. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Subsidiary, Sale of Stock [Line Items]
Cash, cash equivalents, and short-term investments			$ 107,900	$ 139,800
Net loss			117,683	101,981
Net cash used in operating activities			99,682	85,169
Accumulated deficit			478,698	361,015
Working capital			107,800	129,500
Proceeds from sale of convertible preferred stock and convertible debt	$ 253,900
Number of shares issued during the period (in shares)		6,325,000
Proceeds from issuance of common stock, net of issuance costs			$ 82,657	$ 166,286
Proceeds from issuance of common stock		$ 82,700
IPO
Subsidiary, Sale of Stock [Line Items]
Number of shares issued during the period (in shares)	10,147,058
Price per share (in dollars per share)	$ 18.00
Proceeds from issuance of common stock, net of issuance costs	$ 166,300
Over-Allotment Option
Subsidiary, Sale of Stock [Line Items]
Number of shares issued during the period (in shares)	1,323,529	825,000
Price per share (in dollars per share)		$ 14.00
Public Stock Offering
Subsidiary, Sale of Stock [Line Items]
Sale of stock, consideration received on transaction		$ 88,600

Income Taxes - Schedule of Changes to Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at beginning of year	$ 3,397	$ 1,539
Increases related to prior year tax positions	0	1,210
Increases related to current year tax positions	731	648
Balance at end of year	$ 4,128	$ 3,397

Related Party Transactions (Details) - USD ($)	1 Months Ended	12 Months Ended
Related Party Transactions (Details) - USD ($)	Aug. 31, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Related Party Transaction [Line Items]
Preferred stock, par value (in dollars per share)		$ 0.001	$ 0.001
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		$ 40,000,000	$ 40,000,000
Former Director and Shareholder \| Patent Rights from Former Director and Shareholder \| Maximum
Related Party Transaction [Line Items]
Royalty expense			100,000
Beneficial Customer \| Sales
Related Party Transaction [Line Items]
Revenue from related parties			500,000
Director and the Chairman \| Consulting Agreement \| Selling, general and administrative
Related Party Transaction [Line Items]
Consulting fees incurred for related party		100,000	200,000
Director and the Chairman \| IPO \| Selling, general and administrative \| PSUs
Related Party Transaction [Line Items]
Consulting fees incurred for related party			4,600,000
Orbimed Royalty Oppurtunities Two LP and Deerfield Private Design Fund LP \| 2019 Credit Agreement
Related Party Transaction [Line Items]
Line of credit maximum borrowing capacity				$ 70,000,000
Interest expenses related party		$ 5,700,000	$ 5,500,000
Revenue from Contract with Customer Benchmark \| Product Concentration Risk \| Former Director and Shareholder \| Patent Rights from Former Director and Shareholder
Related Party Transaction [Line Items]
Royalty expense as a percentage of net sales		3.00%

401(k) Retirement Plan (Details) - USD ($)	12 Months Ended
401(k) Retirement Plan (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020
401(k) Retirement Plan
Defined Contribution Plan Disclosure [Line Items]
Employer contribution to defined benefit plan	$ 0	$ 0

Stock-Based Compensation - Schedule of Estimate of the Fair Value of Stock Option (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	0.76%	0.35%
Risk-free interest rate, maximum	1.39%	0.90%
Expected dividend yield	0.00%	0.00%
Expected term		7 years
Expected volatility, minimum	60.00%	60.00%
Expected volatility, maximum	75.00%	80.00%
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	7 years

Stock-Based Compensation - Schedule of RSA Activity (Details) - Restricted Stock Awards - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Number of Shares
Unvested balance at beginning of period (in shares)	0	0
Granted (in shares)	186	34,051
Vested (in shares)	(186)	(34,051)
Unvested balance at end of period (in shares)	0	0
Weighted Average Grant Price
Unvested balance at beginning of period (in dollars per share)	$ 0	$ 0
Granted (in dollars per share)	14.75	16.85
Vested (in dollars per share)	14.75	16.85
Unvested balance at end of period (in dollars per share)	$ 0	$ 0

Warrants

12 Months Ended

Dec. 31, 2021

Warrants and Rights Note Disclosure [Abstract]

Warrants

As of December 31, 2021 and 2020, the outstanding warrants to purchase the Company’s common stock were comprised of the following:


	Equity Upon Exercise (After Conversion)	Exercise Price		Expiration Date	December 31, 2021	December 31, 2020
Warrants issued in 2015	Common stock	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	Common stock	$	0.10	6/7/28	346,689	373,810
Warrants issued with 2018 Term Loan	Common stock	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	Common stock	$	16.67	5/20/29	419,992	419,992
Total Warrants					797,487	824,608

The Company’s warrant activity for the years ended December 31, 2021 and 2020 is as follows:


	Warrants	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)
Balance - December 31, 2019	956,552	$	7.88	8.8
Exercised	(131,944)	0.25		7.5
Balance - December 31, 2020	824,608	$	9.10	7.9
Exercised	(26,958)	$	0.10	6.4
Shares withheld for exercise price	(163)	0.10		6.4
Balance - December 31, 2021	797,487	$	9.41	6.9

The Company’s warrants provide the holder the option to purchase a specified number of shares for a specified price. The holder may exercise the warrant in cash or 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.

Prior to the IPO, in accordance with ASC 815, the warrants, other than the ones issued in 2015, were recorded as liabilities at fair value at the issuance date (the 2015 warrants have been equity classified since their issuance). Changes in the fair value were recognized in change in fair value of warrant liability in the consolidated statements of operations and comprehensive loss at the end of each reporting period. On August 10, 2020, in connection with the closing of the IPO, the warrants recorded as liabilities no longer met the definition of a derivative. Accordingly, the fair value of the common and preferred stock warrant liability of $14.5 million was reclassified to additional paid-in capital in the consolidated balance sheet.

In connection with the Exchange Agreements (see Note 15), 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.

Income Taxes - Narrative (Details) - USD ($)	12 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Taxes [Line Items]
Provision for state income taxes	$ 0	$ 23,000
Deferred tax assets, valuation allowance	$ 106,717,000	79,782,000
NOLs carried forward to offset taxable income for 2022 and thereafter	80.00%
Unrecognized tax benefits	$ 4,128,000	3,397,000	$ 1,539,000
Unrecognized tax benefits that, if recognized, would affect the effective tax rate	3,800,000
Interest and penalties accrued	0	0
Interest and/or penalties recognized	0	0
Federal
Income Taxes [Line Items]
NOL carryforwards	415,300,000
NOL carryforwards amount offset will not expire	$ 307,100,000
Tax years remain open for examination, statute of limitation term	3 years
Federal \| R&D Credit Carryforwards
Income Taxes [Line Items]
Tax credit carryforwards	$ 8,100,000
State
Income Taxes [Line Items]
NOL carryforwards	105,700,000
State \| R&D Credit Carryforwards \| California
Income Taxes [Line Items]
Tax credit carryforwards	5,600,000
Foreign Tax Authority
Income Taxes [Line Items]
NOL carryforwards	0
NOL Begin to Expire in 2031 \| Federal
Income Taxes [Line Items]
NOL carryforwards	$ 108,200,000
Minimum \| State \| California
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	$ 0	$ 100,000
Maximum \| State \| California
Income Taxes [Line Items]
Tax years remain open for examination, statute of limitation term	4 years

Operating Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Summary of Quantitative Information About Operating Leases and Components of Lease Cost

The following table summarizes quantitative information about the Company’s operating leases for the years ended December 31, 2021 and 2020 (dollars in thousands):


	Year Ended December 31,
	2021			2020
Operating cash flows from operating leases	$	853		$	1,013

Weighted average remaining lease term – operating leases (in years)	3.6			1.6
Weighted average discount rate – operating leases	7.0		%	7.0		%

The following table provides the components of the Company’s lease cost for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020
Operating leases
Operating lease cost	$	950	$	864
Variable lease cost	325		311
Total rent expense	$	1,275	$	1,175

Summary of Future Minimum Payments Under the Non-cancelable Operating Leases

As of December 31, 2021, future minimum payments under the non-cancelable operating leases were as follows (in thousands):


Year ending December 31, 2022	$	903
Year ending December 31, 2023	1,135
Year ending December 31, 2024	1,167
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Thereafter	1,221
Total	6,762
Less: present value discount	(1,776)
Operating lease liabilities	$	4,986

Warrants - Narrative (Details) $ in Millions	12 Months Ended
Warrants - Narrative (Details) $ in Millions	Dec. 31, 2021 holder	Aug. 10, 2020 USD ($)
Warrants and Rights Note Disclosure [Abstract]
Common and preferred stock warrant liability \| $		$ 14.5
Number of warrant holders \| holder	4
Maximum percentage of outstanding common stock	0.049
Maximum percentage of outstanding common stock, notice for increase	0.099

Inventory

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Inventory

Inventory as of December 31, 2021 and 2020 consisted of the following (in thousands):


	December 31, 2021		December 31, 2020
Raw materials	$	6,779	$	7,960
Work in process	1,772		1,267
Finished goods	7,857		3,731
Total inventory	$	16,408	$	12,958

Warrants - Schedule of Outstanding Warrants to Purchase the Company's Common Stock (Details) - $ / shares	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 9.41	$ 9.10	$ 7.88
Warrants outstanding (in shares)	797,487	824,608	956,552
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	373,810
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 \| Warrants issued with 2019 Credit Agreement
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 16.67
Warrants outstanding (in shares)	419,992	419,992

Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Compensation and related expenses	$ 7,088	$ 6,250
Professional fees	158	120
Deferred revenue	401	301
Sales and use tax	71	169
Clinical studies	541	187
Clinician accounts	358	149
Accrued royalties	129	86
Other	350	46
Total accrued liabilities	$ 9,096	$ 7,308

Lessor Sales-Type Leases - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Lessor, Lease, Description [Line Items]
Lease revenue	$ 1.1	$ 0.8
Prepaid Expenses and Other Current Assets
Lessor, Lease, Description [Line Items]
Lease receivable	0.9	0.4
Other Assets
Lessor, Lease, Description [Line Items]
Lease receivable	$ 0.7	$ 0.4

Convertible Preferred Stock (Tables)

12 Months Ended

Dec. 31, 2021

Temporary Equity [Abstract]

Schedule of Initial Conversion Price per Share for each Series of Convertible Preferred Stock

The initial conversion price per share for each series of convertible preferred stock was the original issue price applicable to such series as follows:


Series	Conversion Price
Series A convertible preferred stock	$	8.295
Series B convertible preferred stock	$	13.370
Series C convertible preferred stock	$	16.667
Series D convertible preferred stock	$	16.667

Stock-Based Compensation

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Stock-Based Compensation

2020 Equity Incentive Plan

The 2020 Equity Incentive Plan (the “2020 Plan”), which permits 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, 2021, 3,313,017 shares of common stock were authorized for issuance under the 2020 Plan and 1,077,978 shares remain available for issuance under the 2020 Plan, including 300,092 shares forfeited under the Company's 2011 Equity Incentive Plan (the “2011 Plan”).

2011 Equity Incentive Plan

The 2011 Plan permits the granting of incentive stock options, non-statutory stock options, restricted stock, restricted stock units and other stock-based awards to employees, directors, officers and consultants. As of December 31, 2021, 2,258,659 shares of common stock were authorized for issuance under the 2011 Plan and no shares remain available for issuance under the 2011 Plan. 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. The Company’s common stock became publicly traded in August 2020 and lacks company-specific historical and implied volatility information. Therefore, 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 has been 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 of the award for time periods approximately equal to the expected term of the award. Expected dividend yield is zero based on the fact that the Company has never paid cash dividends and does not expect to pay any cash dividends in the foreseeable future.

The following assumptions were used to estimate the fair value of stock option for the years ended December 31, 2021 and 2020:


	Year Ended December 31,
	2021	2020
Risk-free interest rate	0.76% - 1.39%	0.35% - 0.90%
Expected dividend yield	—	—
Expected term in years	5.5 - 7	7
Expected volatility	60% - 75%	60% - 80%

The following table summarizes stock option activity during the years ended December 31, 2021 and 2020:


	Stock Options	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2019	2,041,205	$	9.52	7.7	$	10,782
Options granted	1,794,895	16.91
Options exercised	(172,312)	7.52			$	1,660
Options forfeited	(260,181)	12.10
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	3,781,636	$	13.12	7.6	$	93
Options vested and exercisable as of December 31, 2021	1,799,522	$	11.74	6.1	$	64

The aggregate intrinsic value for options outstanding in the above table represents the product of the number of options outstanding multiplied by the difference between the per share fair value of the Company’s stock on the last day of the fiscal period, which was $3.41 and $28.81 as of December 31, 2021 and 2020, respectively, 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, 2021 and 2020 was $8.46 and $11.58, respectively. As of December 31, 2021, the total unrecognized compensation related to unvested

stock option awards granted was $26.6 million, which the Company expects to recognize over a weighted-average period of approximately 2.6 years.

Performance-Based Restricted Stock Units and Restricted Stock Units

In June 2019, the Company granted 567,509 PSUs, with a grant date fair value of $13.37. Vesting of the PSUs was dependent upon the satisfaction of both a service condition and a performance condition, which is an IPO or a change of control. The Company began recording compensation expense related to the PSUs upon the declaration of the Company’s registration statement becoming effective on August 5, 2020, as the performance conditions were satisfied. The compensation expense was determined using the original grant date fair value and is being recognized over the remaining service period.

The Company’s PSU and RSU activity for the years ended December 31, 2021 and 2020 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2019	567,509	$	13.37
Granted	270,718	19.87
Forfeited	(7,386)	18.00
Vested	(285,375)	13.37
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

Restricted Stock Awards

The Company’s RSA activity for the years ended December 31, 2021 and 2020 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2019	—	$	—
Granted	34,051	16.85
Vested	(34,051)	16.85
Unvested as of December 31, 2020	—	$	—
Granted	186	14.75
Vested	(186)	14.75
Unvested as of December 31, 2021	—	$	—

Employee Stock Purchase Plan

The 2020 ESPP, which permits employees to purchase shares of the Company’s common stock, became effective on August 5, 2020 and 387,063 shares of common stock were authorized for sale under the 2020 ESPP.

The 2020 ESPP will be implemented by 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. The first offering period began on February 1, 2021. In November 2021, the Company amended its ESPP offering periods beginning in 2022 after the January 31 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 determinations of the Compensation Committee of the Company’s Board of Directors, in its sole discretion.

The fair value of the 2020 ESPP shares is estimated using the Black-Scholes option pricing model.


	Year Ended December 31,
	2021		2020
Cost of products sold	$	864	$	440
Research and development	2,181		1,002
Selling, general and administrative	10,709		10,661
Total stock-based compensation	$	13,754	$	12,103

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesAs of December 31, 2021, the Company was not a party to any material legal proceedings and is not aware of any pending or threatened claims. From time to time however, the Company may be subject to various legal proceedings and claims that arise in the ordinary course of its business activities. For example, the Company and certain of its current 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 (case numbers 22CV206 and 22CV0388). 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.

Property and Equipment, Net

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

The Company’s property and equipment, net, consisted of the following as of December 31, 2021 and 2020 (in thousands):


	December 31, 2021		December 31, 2020
Medical diagnostic equipment	$	16,759	$	13,242
Furniture and fixtures	433		388
Office equipment	1,538		1,392
Laboratory equipment and software	5,302		3,491
Leasehold improvements	582		608
Construction in process	958		468
Total property and equipment	25,572		19,589
Less: accumulated depreciation	(11,902)		(7,233)
Property and equipment, net	$	13,670	$	12,356

Property and equipment includes certain medical diagnostic equipment, 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 expenses the cost of the equipment when it is subsequently sold or enters into a sales-type lease agreement. See also “Note 6—Lessor Sales-Type Leases” above.

Depreciation expense was $5.8 million and $2.8 million for the years ended December 31, 2021 and 2020, respectively. For the years ended December 31, 2021 and 2020, the Company determined that there was no impairment of property and equipment.

Lessor Sales-Type Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Lessor Sales-Type Leases

The Company recognizes revenue and costs, as well as a lease receivable, at the time embedded sales-type leases within its deferred equipment agreements commence. Lease revenue related to sales-type leases was $1.1 million and $0.8 million for the years ended December 31, 2021 and 2020, respectively, and is included within revenue in the consolidated statements of operations and comprehensive loss. Costs related to embedded leases within the Company’s deferred equipment agreements are included in cost of products sold in the consolidated statements of operations and comprehensive loss.

The Company has a short-term lease receivable of $0.9 million and $0.4 million included in prepaid expenses and other current assets, and a long-term lease receivable of $0.7 million and $0.4 million included in other assets as of December 31, 2021 and 2020, respectively.

As of December 31, 2021, estimated future maturities of customer sales-type lease receivables for each of the following years were as follows (in thousands):


Year ending December 31, 2022	$	859
Year ending December 31, 2023	408
Year ending December 31, 2024	244
Year ending December 31, 2025	71
Year ending December 31, 2026	—
Lease receivable	$	1,582

Income Taxes - Schedule of Components of Income Tax Expense for Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Current tax provision:
Federal	$ 0	$ 0
State	0	23
Foreign	0	0
Total provision for income taxes	$ 0	$ 23

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, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Income tax benefit at federal statutory rate	$ (24,714)	$ (21,411)
Adjustments for tax effects of:
State taxes, net	(2,343)	(2,237)
Permanent adjustments	352	968
Warrants	0	1,167
Research and development credit	(2,255)	(5,870)
Unrecognized tax benefit	676	1,761
Valuation allowance	26,935	26,619
Rate change	532	(737)
Other	817	(237)
Income tax expense	$ 0	$ 23
Income tax benefit at federal statutory rate	21.00%	21.00%
Adjustments for tax effects of:
State taxes, net	2.00%	2.19%
Permanent adjustments	(0.30%)	(0.95%)
Warrants	0.00%	(1.14%)
Research and development credit	1.90%	5.76%
Unrecognized tax benefit	(0.60%)	(1.73%)
Valuation allowance	(22.90%)	(26.11%)
Rate change	(0.50%)	0.72%
Other	(0.60%)	0.23%
Income tax expense	0.00%	(0.03%)

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities
Net loss	$ (117,683)	$ (101,981)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation expense	5,754	2,763
AcQMap Systems converted to sales	2,182	0
Sales-type lease loss	28	0
Amortization of intangible assets	640	457
Non-cash stock-based compensation expense	13,754	12,103
Amortization of premiums/(accretion of discounts) on marketable securities, net	1,277	484
Amortization of debt issuance costs	1,404	767
Amortization of right-of-use assets	496	684
Change in fair value of warrant liability	0	5,555
Change in fair value of contingent consideration	(3,746)	97
Changes in operating assets and liabilities:
Accounts receivable	(1,473)	(1,897)
Inventory	(3,872)	(3,891)
Prepaid expenses and other current assets	1,133	(3,383)
Other assets	304	(622)
Accounts payable	(871)	2,283
Accrued liabilities	1,549	2,232
Operating lease liabilities	(608)	(820)
Other long-term liabilities	50	0
Net cash used in operating activities	(99,682)	(85,169)
Cash flows from investing activities
Purchases of available-for-sale marketable securities	(87,258)	(114,694)
Sales of available-for-sale marketable securities	8,590	17,095
Maturities of available-for-sale marketable securities	107,707	45,000
Purchases of property and equipment	(9,973)	(11,225)
Net cash provided by (used in) investing activities	19,066	(63,824)
Cash flows from financing activities
Payment of deferred offering costs	(580)	0
Payment of contingent consideration	(3,435)	(2,500)
Payment of contingent consideration into escrow	(224)	0
Proceeds from employee stock purchase plan	440	0
Proceeds from warrants exercises	0	13
Proceeds from issuance of common stock, net of issuance costs	82,657	166,286
Proceeds from stock options exercises	711	634
Net cash provided by financing activities	79,569	164,433
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(116)	342
Net change in cash, cash equivalents and restricted cash	(1,163)	15,782
Cash, cash equivalents and restricted cash, at the beginning of the period	25,384	9,602
Cash, cash equivalents and restricted cash, at the end of the period	24,221	25,384
Supplemental disclosure of cash flow information:
Cash paid for interest	4,259	4,676
Supplemental disclosure of noncash investing and financing activities:
Issuance of Series D convertible preferred stock for Biotronik asset purchase	0	5,000
Issuance of Series D convertible preferred stock for Rhythm Xience Acquisition	0	2,197
Change in unrealized loss on marketable securities	37	53
Right-of-use assets exchanged for operating lease liabilities	3,527	0
Accrued licensed intangibles assets	0	2,000
Change in unpaid purchases of property and equipment	124	101
Unpaid deferred offering costs	0	643
Net book value of AcQMap System sales-type leases	1,104	0
Conversion of convertible preferred stock into common stock upon IPO	0	260,555
Reclassification of warrant liability to additional paid-in capital	$ 0	$ 14,474

Stockholders’ Equity	12 Months Ended
Stockholders’ Equity	Dec. 31, 2021
Equity [Abstract]
Stockholders’ Equity	Stockholders’ Equity 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. In connection with the issuance of Series A Common Equivalent 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, par value $0.001 per share, of the Company (the “Series A Certificate of Designation”) with the Secretary of State of the State of Delaware. The Series A Common Equivalent 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 Series A Common Equivalent 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 Series A Common Equivalent Preferred Stock is non-voting. The holder thereof may convert each share of Series A Common Equivalent Preferred Stock into 1,000 shares of common stock at its election, 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 Securities Exchange Act of 1934, as amended (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, to 9.9%) of the total number of shares of common stock then issued and outstanding. 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. 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 from the offering On August 10, 2020, the Company issued 10,147,058 shares of common stock in its IPO, which included 1,323,529 shares of common stock issued upon the underwriters’ exercise in full of an option to purchase, at the public offering price less underwriting discounts and commissions, up to an additional 1,323,529 shares. The price to the public for each share was $18.00. The Company received gross proceeds of $182.6 million from the IPO. Net of underwriting discounts and commission and other offering costs, the Company received net proceeds of $166.3 million from the IPO. On August 10, 2020, in connection with the closing of the IPO, the Company filed an amended and restated certificate of incorporation (the “A&R Certificate”) with the Secretary of State of the State of Delaware. The A&R Certificate amended and restated the Company’s authorized shares of common stock to 260,000,000 and authorized shares of undesignated preferred stock to 5,000,000. During the year ended December 31, 2021 and 2020, stock options to acquire 111,804 shares and 124,938 shares were exercised for shares of common stock. The Company received $0.7 million and $0.6 million for the exercise price of the stock options for the year ended December 31, 2021 and 2020, respectively. Additionally, during the year ended December 31, 2021, in conjunction with the 2020 Employee Stock Purchase Plan (the “2020 ESPP”), 33,641 shares of common stock were issued for consideration of $0.4 million (see Note 16). No shares were issued related to the 2020 ESPP plan for the year ended December 31, 2020. During the year ended December 31, 2021, the Company issued 134,050 shares of common stock upon vesting of RSUs and 186 shares of common stock for RSAs. During the year ended December 31, 2020, the Company issued 285,369 shares of common stock upon vesting of RSUs and 34,051 shares of common stock for RSAs.

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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-Subparagraph (b)
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
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-URI http://asc.fasb.org/extlink&oid=123467817&loc=SL123496158-112644

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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-Section 50
-Paragraph 14
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123467817&loc=SL123496171-112644

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=123467817&loc=SL123496171-112644

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.3-04)
-URI http://asc.fasb.org/extlink&oid=120397183&loc=d3e187085-122770

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 18
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123467817&loc=SL123496189-112644

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-URI http://asc.fasb.org/topic&trid=2208762

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Marketable Securities - Summary of Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	$ 83,867	$ 114,573
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(45)	(8)
Fair Value	83,822	114,565
Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	76,741	105,847
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(39)	(8)
Fair Value	76,702	105,839
Long-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	7,126
Gross Unrealized Gains	0
Gross Unrealized Losses	(6)
Fair Value	7,120	8,700
Corporate debt securities \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	15,786	31,359
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(6)	(6)
Fair Value	15,780	31,353
Corporate debt securities \| Long-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	3,082
Gross Unrealized Gains	0
Gross Unrealized Losses	(2)
Fair Value	3,080
U.S. treasury securities \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	5,073	20,533
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(9)	(2)
Fair Value	5,064	20,531
Commercial paper \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	36,759	53,955
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	36,759	53,955
Yankee debt securities \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	3,941
Gross Unrealized Gains	0
Gross Unrealized Losses	(9)
Fair Value	3,932
Supranational \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	3,054
Gross Unrealized Gains	0
Gross Unrealized Losses	(3)
Fair Value	3,051
Asset-backed securities \| Short-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	12,128
Gross Unrealized Gains	0
Gross Unrealized Losses	(12)
Fair Value	12,116
Asset-backed securities \| Long-term debt
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	4,044	8,726
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(4)	0
Fair Value	$ 4,040	$ 8,726

Goodwill and Intangible Assets - Summary of Remaining Amortization Expense Associated with Amortizable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Year ending December 31, 2022	$ 640
Year ending December 31, 2023	640
Year ending December 31, 2024	630
Year ending December 31, 2025	620
Year ending December 31, 2026	620
Thereafter	1,863
Finite-Lived Intangible Assets, Net	5,013	$ 5,653	$ 4,110
Developed technology
Finite-Lived Intangible Assets [Line Items]
Year ending December 31, 2022	420
Year ending December 31, 2023	420
Year ending December 31, 2024	420
Year ending December 31, 2025	420
Year ending December 31, 2026	420
Thereafter	1,080
Finite-Lived Intangible Assets, Net	3,180	3,600
Customer-related intangible
Finite-Lived Intangible Assets [Line Items]
Year ending December 31, 2022	20
Year ending December 31, 2023	20
Year ending December 31, 2024	10
Year ending December 31, 2025	0
Year ending December 31, 2026	0
Thereafter	0
Finite-Lived Intangible Assets, Net	50	70
Licensed intangibles
Finite-Lived Intangible Assets [Line Items]
Year ending December 31, 2022	200
Year ending December 31, 2023	200
Year ending December 31, 2024	200
Year ending December 31, 2025	200
Year ending December 31, 2026	200
Thereafter	783
Finite-Lived Intangible Assets, Net	$ 1,783	$ 1,983

Goodwill and Intangible Assets - Summary of Goodwill and Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill
Balance at beginning of period	$ 12,026	$ 12,026
Balance at end of period	12,026	12,026
Intangible Assets
Balance at beginning of period	5,653	4,110
Amortization expense	(640)	(457)
Balance at end of period	$ 5,013	5,653
Biotronik Asset Acquisition
Goodwill
Biotronik license agreement		0
Intangible Assets
Biotronik license agreement		$ 2,000

Operating Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

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.

The Company also 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 Company has a renewal option for an additional three-year term upon the expiration date of the lease, which has been included in the calculation of the right-of-use asset as it is reasonably certain to be exercised.

The following table summarizes quantitative information about the Company’s operating leases for the years ended December 31, 2021 and 2020 (dollars in thousands):


	Year Ended December 31,
	2021			2020
Operating cash flows from operating leases	$	853		$	1,013

Weighted average remaining lease term – operating leases (in years)	3.6			1.6
Weighted average discount rate – operating leases	7.0		%	7.0		%

The following table provides the components of the Company’s lease cost for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020
Operating leases
Operating lease cost	$	950	$	864
Variable lease cost	325		311
Total rent expense	$	1,275	$	1,175

As of December 31, 2021, future minimum payments under the non-cancelable operating leases were as follows (in thousands):


Year ending December 31, 2022	$	903
Year ending December 31, 2023	1,135
Year ending December 31, 2024	1,167
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Thereafter	1,221
Total	6,762
Less: present value discount	(1,776)
Operating lease liabilities	$	4,986

Convertible Preferred Stock - Schedule of Initial Conversion Price Per Share for each Series of Convertible Preferred Stock (Details)	Dec. 31, 2021 $ / shares
Series A convertible preferred stock
Temporary Equity [Line Items]
Temporary equity initial conversion price per share (in dollars per share)	$ 8.295
Series B convertible preferred stock
Temporary Equity [Line Items]
Temporary equity initial conversion price per share (in dollars per share)	13.370
Series C convertible preferred stock
Temporary Equity [Line Items]
Temporary equity initial conversion price per share (in dollars per share)	16.667
Series D convertible preferred stock
Temporary Equity [Line Items]
Temporary equity initial conversion price per share (in dollars per share)	$ 16.667

Lessor Sales-Type Leases - Estimated Future Maturities of Customer Sales-Type Lease Receivables (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Leases [Abstract]
Year ending December 31, 2022	$ 859
Year ending December 31, 2023	408
Year ending December 31, 2024	244
Year ending December 31, 2025	71
Year ending December 31, 2026	0
Lease receivable	$ 1,582

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 640	$ 457

Commitments and Contingencies (Details)	Dec. 31, 2021 lawsuit
Commitments and Contingencies Disclosure [Abstract]
Loss contingency, pending claims, number	2

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Summary of Goodwill and Intangible Assets Activities

The tables below summarize goodwill and intangible assets activities as of December 31, 2021 and 2020 (in thousands):


	Goodwill		Intangible Assets
Balance, December 31, 2019	$	12,026	$	4,110
Biotronik license agreement	—		2,000
Amortization expense	—		(457)
Balance, December 31, 2020	12,026		5,653

Amortization expense	—		(640)
Balance, December 31, 2021	$	12,026	$	5,013

Summary of Finite Lived Intangible Assets


	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		December 31, 2021
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			$	6,300	$	(1,287)	$	5,013


	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		December 31, 2020
Developed technology	10	8.6	$	4,200	$	(600)	$	3,600
Customer-related intangible	5	3.5	100		(30)		70
Licensed intangibles	10	9.9	2,000		(17)		1,983
Total			$	6,300	$	(647)	$	5,653

Summary of Remaining Amortization Expense

The following table shows the remaining amortization expense associated with amortizable intangible assets as of December 31, 2021 (in thousands):


	Developed Technology		Customer- Related Intangible		Licensed Intangibles		Total Amortization
Year ending December 31, 2022	$	420	$	20	$	200	$	640
Year ending December 31, 2023	420		20		200		640
Year ending December 31, 2024	420		10		200		630
Year ending December 31, 2025	420		—		200		620
Year ending December 31, 2026	420		—		200		620
Thereafter	1,080		—		783		1,863
Total	$	3,180	$	50	$	1,783	$	5,013

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2021
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. The most significant estimates and assumptions in the Company’s consolidated financial statements include, but are not limited to, revenue recognition, useful lives of intangible assets, assessment of impairment of goodwill, measurement of operating lease liabilities, and the fair value of common stock, stock options, warrants, intangible assets, contingent consideration and goodwill. 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 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, 2021 and 2020, exceeded federally insured limits. Restricted cash serves as collateral for the Company’s corporate credit card program.
Marketable Securities	Marketable 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 (deficit) until their disposition or maturity. See “Fair Value Measurements” below. 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 did not record any 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, 2021 or 2020.
Concentrations of Credit Risk and Off-Balance Sheet Risk	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. The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities, Yankee debt securities, supranational, asset-backed securities and short-term high credit quality corporate debt securities.
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 if 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, 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, customers purchase disposable products using separate purchase orders after the equipment has been provided to the customer for free with no binding agreement or requirement to purchase any disposable products. 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. 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 to four years. The Company has determined that the deferred equipment agreements include an embedded sales-type lease. The Company allocates contract consideration under deferred equipment agreements containing fixed annual disposable purchase commitments to the underlying lease and non-lease components at contract inception. The Company expenses the cost of the device at the inception of the agreement and records a financial lease asset equal to the gross consideration allocated to the lease. The lease asset will be reduced by payments for minimum disposable purchases that are allocated to the lease. Lastly, the Company enters into short-term operating leases, for the rental of the 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 SE & Co. KG (“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 includes, but is not limited to, transactions where the specific performance obligations are sold separately, list prices and 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, 2021 and 2020. In May 2020, the Company entered into bi-lateral distribution agreements with Biotronik (the “Bi-Lateral Distribution Agreements”). 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 to the other party specified transfer prices 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.
Inventory	Inventory Inventory is comprised of raw materials, direct labor and manufacturing overhead and 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 based on management’s review of inventories on hand, compared to estimated future usage and sales, shelf-life and assumptions about the likelihood of obsolescence of $1.3 million and $0.1 million for the years ended December 31, 2021 and 2020, respectively.
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, 2021 or 2020.
Property and Equipment, Net	Property and Equipment, Net Property and equipment are recorded at cost. Depreciation and amortization are provided using the straight-line method over the estimated useful lives of the related assets, generally three to five years, or, in the case of leasehold improvements, over the lesser of the useful life of the related asset or the lease term.
Intangible Assets	Intangible Assets Intangible assets consist of acquired developed technology, acquired in-process technology, trademarks and trade names and a customer-related intangible which were acquired as part of the acquisition of Rhythm Xience, Inc. (“Rhythm Xience”) in June 2019. 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 was classified as an indefinite-lived intangible asset, until the receipt of U.S. Food and Drug Administration (“FDA”) approval for the technology in January 2020. Once the FDA approval was received, the in-process technology was classified as a finite-lived intangible and amortization for in-process technology began. 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, and it is presented as goodwill in the accompanying consolidated balance sheets. 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 could first assess 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. The Company has one reporting unit. For the years ended December 31, 2021 and 2020, the quantitative testing did not indicate any impairment for the carrying amount of goodwill.
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, 2021 and 2020, the Company determined that there was no impairment of property and equipment or intangible assets.
Foreign Currency Translation and Transactions	Foreign Currency Translation and Transactions The assets, liabilities and results of operations of Acutus NV are measured using their functional currency, the Euro, which is the currency of the primary foreign economic environment in which this subsidiary operates. Upon consolidating this entity 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.
Lessee Leases	Lessee Leases The Company accounts for its leases 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. 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 has elected to combine lease and non-lease components. The Company excludes short-term leases having initial terms of twelve months or less from the new guidance as an accounting policy election.
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. In April 2021, the Company and Biotronik entered into a Feasibility and Development Agreement to pursue the development of hardware, software and IT infrastructure to implement the Qubic Connect System (“QBS”). The QBS will allow data transfer from multiple diagnostic and therapeutic medical products during an electrophysiology procedure to be aggregated and analyzed for the purposes of designing improved treatment protocols. 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 expenses 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 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 has been used in determining the inputs used in 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 that are financial instruments whose values are determined 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, 2021 and 2020. As of December 31, 2021 and 2020, 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 the instruments. 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 Company’s portfolio of marketable securities is comprised of commercial paper, asset-backed securities, U.S. treasury securities, Yankee debt securities, supranational and short-term highly liquid, high credit quality corporate debt securities. The fair value for the available-for-sale marketable securities is determined based on trade prices in active markets for identical assets (Level 1 inputs) or 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.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. 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, and any increase or decrease is recorded in operating 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.
Stock-Based Compensation	Stock-Based Compensation The Company accounts for all stock-based payments to employees and non-employees, including grants of stock options, restricted stock awards (“RSAs”), restricted stock units (“RSUs”) and restricted stock units with non-market performance and service conditions (“PSUs”) 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 RSAs, RSUs and PSUs are valued based on the fair value of the Company’s common stock on the date of grant. The assumptions used in calculating the fair value of stock-based awards represent management’s best estimates and involve inherent uncertainties and the application of management’s judgment. The Company expenses stock-based compensation related to stock options, RSAs and RSUs over the requisite service period. As the PSUs have a performance condition, compensation expense was recognized for each vesting tranche over the respective requisite service period of each tranche upon the registration statement becoming effective on August 5, 2020, when the Company’s management deemed it probable that the performance conditions were satisfied. The Company recognized a cumulative true-up adjustment related to PSUs once the conditions became probable of being satisfied as the related service period had been completed in a prior 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 also “Note 16—Stock-Based Compensation” below.
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 net operating loss (“NOL”) carryforwards and research and development (“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.
Warrant Liability	Warrant LiabilityThe Company accounted for certain common stock warrants and convertible preferred stock warrants outstanding as a liability, in accordance with ASC 815, Derivatives and Hedging (“ASC 815”), at fair value. This liability was subject to re-measurement at each reporting period and upon conversion to equity-classified warrants, and any change in fair value was recognized in the consolidated statements of operations and comprehensive loss. In connection with the IPO on August 10, 2020, the common stock warrants and convertible preferred stock warrants that had been liability-classified were automatically converted into an equal number of warrants to purchase common stock and became equity-classified. The fair value of the outstanding liability on the conversion date was reclassified to additional paid-in capital in the Company’s consolidated balance sheet.
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 represents the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired.
Recently Adopted Accounting Pronouncements and Accounting Pronouncements to Be Adopted	Recently Adopted Accounting Pronouncements In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which is intended to simplify various aspects related to accounting for income taxes. ASU No. 2019-12 removes certain exceptions to the general principles in ASC 740 and also clarifies and amends existing guidance to improve consistent application. This guidance is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. The Company adopted this guidance in the first quarter of 2021, which did not have a material impact on its consolidated financial statements. Accounting Pronouncements to Be Adopted In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326). The ASU 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. This ASU is effective for smaller reporting companies in 2023. The Company is currently assessing the impact of the adoption of this ASU on its consolidated financial statements. In March 2020, the FASB issued ASU No. 2020-4, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides temporary optional guidance to ease the potential burden in accounting for reference rate reform. The new guidance provides optional expedients and exceptions for applying U.S. GAAP to transactions affected by reference rate reform if certain criteria are met. These transactions include: contract modifications, hedging relationships and sale or transfer of debt securities classified as held-to-maturity. Entities may apply the provisions of the new standard as of the beginning of the reporting period when the election is made (i.e., as early as the first quarter 2020). Unlike other topics, the provisions of this update are only available until December 31, 2022, when the reference rate replacement activity is expected to have been completed. The Company is currently evaluating the impact of this standard on its consolidated financial statements and has yet to elect an adoption date. 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), 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. This ASU is effective for smaller reporting companies in 2022. The Company does not expect the impact of the adoption of this ASU to have a material effect on its consolidated financial statements. In May 2021, the FASB issued ASU No. 2021-05, Leases (Topic 842), Lessors – Certain Leases with Variable Lease Payments, 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 does not expect the impact of the adoption of this ASU to have a material effect on its consolidated financial statements.

Net Loss Per Common Share (Tables)

12 Months Ended

Dec. 31, 2021

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,
Shares issuable upon:	2021	2020




Conversion of Series A Common Equivalent Preferred Stock	6,665,841	—
Exercise of stock options	3,781,636	3,403,607
Exercise of common stock warrants	797,487	824,608

Vesting of PSUs and RSUs	995,091	545,466
Total	12,240,055	4,773,681

Inventory (Tables)

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Summary of Inventory

Inventory as of December 31, 2021 and 2020 consisted of the following (in thousands):


	December 31, 2021		December 31, 2020
Raw materials	$	6,779	$	7,960
Work in process	1,772		1,267
Finished goods	7,857		3,731
Total inventory	$	16,408	$	12,958

Warrants (Tables)

12 Months Ended

Dec. 31, 2021

Warrants and Rights Note Disclosure [Abstract]

Schedule of Outstanding Warrants to Purchase the Company's Common Stock

As of December 31, 2021 and 2020, the outstanding warrants to purchase the Company’s common stock were comprised of the following:


	Equity Upon Exercise (After Conversion)	Exercise Price		Expiration Date	December 31, 2021	December 31, 2020
Warrants issued in 2015	Common stock	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	Common stock	$	0.10	6/7/28	346,689	373,810
Warrants issued with 2018 Term Loan	Common stock	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	Common stock	$	16.67	5/20/29	419,992	419,992
Total Warrants					797,487	824,608

The Company’s warrant activity for the years ended December 31, 2021 and 2020 is as follows:


	Warrants	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)
Balance - December 31, 2019	956,552	$	7.88	8.8
Exercised	(131,944)	0.25		7.5
Balance - December 31, 2020	824,608	$	9.10	7.9
Exercised	(26,958)	$	0.10	6.4
Shares withheld for exercise price	(163)	0.10		6.4
Balance - December 31, 2021	797,487	$	9.41	6.9

Schedule of Warrant Activity

As of December 31, 2021 and 2020, the outstanding warrants to purchase the Company’s common stock were comprised of the following:


	Equity Upon Exercise (After Conversion)	Exercise Price		Expiration Date	December 31, 2021	December 31, 2020
Warrants issued in 2015	Common stock	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	Common stock	$	0.10	6/7/28	346,689	373,810
Warrants issued with 2018 Term Loan	Common stock	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	Common stock	$	16.67	5/20/29	419,992	419,992
Total Warrants					797,487	824,608

The Company’s warrant activity for the years ended December 31, 2021 and 2020 is as follows:


	Warrants	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)
Balance - December 31, 2019	956,552	$	7.88	8.8
Exercised	(131,944)	0.25		7.5
Balance - December 31, 2020	824,608	$	9.10	7.9
Exercised	(26,958)	$	0.10	6.4
Shares withheld for exercise price	(163)	0.10		6.4
Balance - December 31, 2021	797,487	$	9.41	6.9

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

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. The most significant estimates and assumptions in the Company’s consolidated financial statements include, but are not limited to, revenue recognition, useful lives of intangible assets, assessment of impairment of goodwill, measurement of operating lease liabilities, and the fair value of common stock, stock options, warrants, intangible assets, contingent consideration and goodwill. 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 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, 2021 and 2020, exceeded federally insured limits.

Restricted cash serves as collateral for the Company’s corporate credit card program. 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, 2021		December 31, 2020
Cash and cash equivalents	$	24,071	$	25,234
Restricted cash	150		150
Total cash, cash equivalents and restricted cash	$	24,221	$	25,384

Marketable 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 (deficit) until their disposition or maturity. See “Fair Value Measurements” below. 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 did not record any 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, 2021 or 2020.

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. The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities, Yankee debt securities, supranational, asset-backed securities and short-term high credit quality corporate debt securities.

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 if 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, 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, customers purchase disposable products using separate purchase orders after the equipment has been provided to the customer for free with no binding agreement or requirement to purchase any disposable products. 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.

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 to four years. The Company has determined that the deferred equipment agreements include an embedded sales-type lease. The Company allocates contract consideration under deferred equipment agreements containing fixed annual disposable purchase commitments to the underlying lease and non-lease components at contract inception. The Company expenses the cost of the device at the inception of the agreement and records a financial lease asset equal to the gross

consideration allocated to the lease. The lease asset will be reduced by payments for minimum disposable purchases that are allocated to the lease.

Lastly, the Company enters into short-term operating leases, for the rental of the 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 SE & Co. KG (“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 includes, but is not limited to, transactions where the specific performance obligations are sold separately, list prices and 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, 2021 and 2020.

In May 2020, the Company entered into bi-lateral distribution agreements with Biotronik (the “Bi-Lateral Distribution Agreements”). 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 to the other party specified transfer prices 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.

The following table sets forth the Company’s revenue for disposables, systems, and service/other for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020

Disposables	$	11,938	$	6,713
Systems	4,058		1,660
Service/Other	1,267		91
Total revenue	$	17,263	$	8,464

The following table provides revenue by geographic location for the years ended December 31, 2021 and 2020 (in thousands):


	Year Ended December 31,
	2021		2020

United States	$	8,325	$	4,854
Outside the United States	8,938		3,610
Total revenue	$	17,263	$	8,464

Inventory

Inventory is comprised of raw materials, direct labor and manufacturing overhead and 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 based on management’s review of inventories on hand, compared to estimated future usage and sales, shelf-life and assumptions about the likelihood of obsolescence of $1.3 million and $0.1 million for the years ended December 31, 2021 and 2020, respectively.

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, 2021 or 2020.

Property and Equipment, Net

Property and equipment are recorded at cost. Depreciation and amortization are provided using the straight-line method over the estimated useful lives of the related assets, generally three to five years, or, in the case of leasehold improvements, over the lesser of the useful life of the related asset or the lease term.

Intangible Assets

Intangible assets consist of acquired developed technology, acquired in-process technology, trademarks and trade names and a customer-related intangible which were acquired as part of the acquisition of Rhythm Xience, Inc. (“Rhythm Xience”) in June 2019. 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 was classified as an indefinite-lived intangible asset, until the receipt of U.S. Food and Drug Administration (“FDA”) approval for the technology in January 2020. Once the FDA approval was received, the in-process technology was classified as a finite-lived intangible and amortization for in-process technology began. 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 represents the excess of the purchase price of an entity over the estimated fair value of the assets acquired and liabilities assumed, and it is presented as goodwill in the accompanying consolidated balance sheets. 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 could first assess 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. The Company has one reporting unit. For the years ended December 31, 2021 and 2020, the quantitative testing did not indicate any impairment for the carrying amount of goodwill.

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, 2021 and 2020, the Company determined that there was no impairment of property and equipment or intangible assets.

Foreign Currency Translation and Transactions

The assets, liabilities and results of operations of Acutus NV are measured using their functional currency, the Euro, which is the currency of the primary foreign economic environment in which this subsidiary operates. Upon consolidating this entity 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.

Lessee Leases

The Company accounts for its leases 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. 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 has elected to combine lease and non-lease components. The Company excludes short-term leases having initial terms of twelve months or less from the new guidance as an accounting policy election.

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.

In April 2021, the Company and Biotronik entered into a Feasibility and Development Agreement to pursue the development of hardware, software and IT infrastructure to implement the Qubic Connect System (“QBS”). The QBS will allow data transfer

from multiple diagnostic and therapeutic medical products during an electrophysiology procedure to be aggregated and analyzed for the purposes of designing improved treatment protocols.

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 expenses 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 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 has been used in determining the inputs used in 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 that are financial instruments whose values are determined 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, 2021 and 2020.

As of December 31, 2021 and 2020, 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 the instruments. 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.


	Fair Value Measured as of December 31, 2021
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Fair Value at December 31, 2021
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


	Fair Value Measured as of December 31, 2020
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Fair Value at December 31, 2020
Assets included in:
Cash and cash equivalents
Money market securities	$	19,070	$	—	$	—	$	19,070
Marketable securities at fair value
Corporate debt securities	—		31,353		—		31,353
Asset-backed securities	—		8,726		—		8,726
U.S. treasury securities	—		20,531		—		20,531
Commercial paper	—		53,955		—		53,955
Total fair value	$	19,070	$	114,565	$	—	$	133,635

Liabilities included in:
Contingent consideration	$	—	$	—	$	9,300	$	9,300
Total fair value	$	—	$	—	$	9,300	$	9,300

The fair value of the Company’s money market funds is determined using quoted market prices in active markets for identical assets.

The Company’s portfolio of marketable securities is comprised of commercial paper, asset-backed securities, U.S. treasury securities, Yankee debt securities, supranational and short-term highly liquid, high credit quality corporate debt securities. The fair value for the available-for-sale marketable securities is determined based on trade prices in active markets for identical

assets (Level 1 inputs) or 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.

The following table presents changes in Level 3 liabilities measured at fair value for the years ended December 31, 2021 and 2020 (in thousands):


	Common and Preferred Stock Warrant Liability		Contingent Consideration		Total
Balance, December 31, 2019	$	8,919	$	13,900	$	22,819
Payment of contingent consideration	—		(2,500)		(2,500)
Issuance of preferred stock for contingent consideration	—		(2,197)		(2,197)
Reclassification of warrant liability to additional paid-in capital	(14,474)		—		(14,474)
Change in fair value	5,555		97		5,652
Balance, December 31, 2020	$	—	$	9,300	$	9,300
Payment of contingent consideration	—		(3,435)		(3,435)
Escrow release	—		(119)		(119)
Change in fair value	—		(3,746)		(3,746)
Balance, December 31, 2021	$	—	$	2,000	$	2,000

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.

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. 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, and any increase or decrease is recorded in operating 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 aggregate) significant unobservable inputs (Level 3 inputs) used in measuring the contingent consideration from the acquisition of Rhythm Xience as of December 31, 2021 and December 31, 2020 were as follows:


	December 31, 2021	December 31, 2020
Risk-free interest rate	0.60%	0.20%
Expected term in years	1.0 - 2.0	1.0 - 2.0
Expected volatility	28.8%	17.2%

Stock-Based Compensation

The Company accounts for all stock-based payments to employees and non-employees, including grants of stock options, restricted stock awards (“RSAs”), restricted stock units (“RSUs”) and restricted stock units with non-market performance and service conditions (“PSUs”) 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 RSAs, RSUs and PSUs are valued based on the fair value of the Company’s common stock on the date of grant. The assumptions used in calculating the fair value of stock-based awards represent management’s best estimates and involve inherent uncertainties and the application of management’s judgment. The Company expenses stock-based compensation related to stock options, RSAs and RSUs over the requisite service period. As the PSUs have a performance condition, compensation expense was recognized for each vesting tranche over the respective requisite service period of each tranche upon the registration statement becoming effective on August 5, 2020, when the Company’s management deemed it probable that the performance conditions were satisfied. The Company recognized a cumulative true-up adjustment related to PSUs once the conditions became probable of being satisfied as the related service period had been completed in a prior 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 also “Note 16—Stock-Based Compensation” below.

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 net operating loss (“NOL”) carryforwards and research and development (“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.

Warrant Liability

The Company accounted for certain common stock warrants and convertible preferred stock warrants outstanding as a liability, in accordance with ASC 815, Derivatives and Hedging (“ASC 815”), at fair value. This liability was subject to re-measurement at each reporting period and upon conversion to equity-classified warrants, and any change in fair value was recognized in the consolidated statements of operations and comprehensive loss. In connection with the IPO on August 10, 2020, the common stock warrants and convertible preferred stock warrants that had been liability-classified were automatically converted into an equal number of warrants to purchase common stock and became equity-classified. The fair value of the outstanding liability on the conversion date was reclassified to additional paid-in capital in the Company’s consolidated balance sheet.

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 represents the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired.

Recently Adopted Accounting Pronouncements

In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which is intended to simplify various aspects related to accounting for income taxes. ASU No. 2019-12 removes certain exceptions to the general principles in ASC 740 and also clarifies and amends existing guidance to improve consistent application. This guidance is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. The Company adopted this guidance in the first quarter of 2021, which did not have a material impact on its consolidated financial statements.

Accounting Pronouncements to Be Adopted

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326). The ASU 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. This ASU is effective for smaller reporting companies in 2023. The Company is currently assessing the impact of the adoption of this ASU on its consolidated financial statements.

In March 2020, the FASB issued ASU No. 2020-4, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides temporary optional guidance to ease the potential burden in accounting for reference rate reform. The new guidance provides optional expedients and exceptions for applying U.S. GAAP to transactions affected by reference rate reform if certain criteria are met. These transactions include: contract modifications, hedging relationships and sale or transfer of debt securities classified as held-to-maturity. Entities may apply the provisions of the new standard as of the beginning of the reporting period when the election is made (i.e., as early as the first quarter 2020). Unlike other topics, the provisions of this update are only available until December 31, 2022, when the reference rate replacement activity is expected to have been completed. The Company is currently evaluating the impact of this standard on its consolidated financial statements and has yet to elect an adoption date.

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), 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. This ASU is effective for smaller reporting companies in 2022. The Company does not expect the impact of the adoption of this ASU to have a material effect on its consolidated financial statements.

In May 2021, the FASB issued ASU No. 2021-05, Leases (Topic 842), Lessors – Certain Leases with Variable Lease Payments, 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 does not expect the impact of the adoption of this ASU to have a material effect on its consolidated financial statements.

Stock-Based Compensation - Summary of Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Stock Options
Outstanding at beginning of period (in shares)	3,403,607	2,041,205
Options granted (in shares)	1,196,281	1,794,895
Options exercised (in shares)	(111,804)	(172,312)
Options forfeited (in shares)	(706,448)	(260,181)
Outstanding at end of period (in shares)	3,781,636	3,403,607	2,041,205
Options vested and exercisable as of December 31, 2021 (in shares)	1,799,522
Weighted Average Exercise Price
Outstanding at beginning of period (in dollars per share)	$ 13.32	$ 9.52
Options granted (in dollars per share)	12.89	16.91
Options exercised (in dollars per share)	6.36	7.52
Options forfeited (in dollars per share)	14.76	12.10
Outstanding at end of period (in dollars per share)	13.12	$ 13.32	$ 9.52
Options vested and exercisable as of December 31, 2021 (in dollars per share)	$ 11.74
Stock Options Activity, Additional Disclosures
Weighted average remaining contractual life, Outstanding	7 years 7 months 6 days	8 years 1 month 6 days	7 years 8 months 12 days
Weighted average remaining contractual life, Options vested and exercisable at end of period (unaudited)	6 years 1 month 6 days
Aggregate intrinsic value, Outstanding balance at beginning of period	$ 52,866	$ 10,782
Aggregate intrinsic value, Options exercised	2,799	1,660
Aggregate intrinsic value, Outstanding balance at end of period	93	$ 52,866	$ 10,782
Aggregate intrinsic value, Options vested and exercisable at end of period	$ 64