0001628280-23-017635 | 10-Q | XBRL Viewer

Marketable Securities (Tables)

3 Months Ended

Mar. 31, 2023

Investments, Debt and Equity Securities [Abstract]

Marketable securities consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023 (unaudited)
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
U.S. treasury securities	$	21,809	$	5	$	—	$	21,814
Commercial paper	21,806		—		—		21,806
Yankee debt securities	3,220		—		(1)		3,219
Total available-for-sale securities - short-term	46,835		5		(1)		46,839
Total available-for-sale securities	$	46,835	$	5	$	(1)	$	46,839


	December 31, 2022
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
U.S. treasury securities	$	26,906	$	3	$	(12)	$	26,897
Commercial paper	3,200		2		—		3,202
Yankee debt securities	14,764		—		—		14,764
Total available-for-sale securities - short-term	44,870		5		(12)		44,863
Total available-for-sale securities	$	44,870	$	5	$	(12)	$	44,863

Debt - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	Jun. 30, 2022	Mar. 31, 2023
Vesting of RSUs and RSAs
Debt Instrument [Line Items]
Class of warrants number of securities called by the warrants or rights (in shares)	3,779,018
Class of warrants, exercise price (in dollars per share)	$ 1.1114
Warrant, term	8 years
2022 Amended Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Face amount	$ 35.0
Debt instrument, term	5 years
Fee amount	$ 1.8	$ 1.8
2022 Amended Credit Agreement \| Senior Term Loan \| End of Month 36
Debt Instrument [Line Items]
Periodic payment, percentage of principal	15.00%
2022 Amended Credit Agreement \| Senior Term Loan \| End of Month 48
Debt Instrument [Line Items]
Periodic payment, percentage of principal	15.00%
2022 Amended Credit Agreement \| Senior Term Loan \| End of Month 60
Debt Instrument [Line Items]
Periodic payment, percentage of principal	70.00%
2022 Amended Credit Agreement \| Senior Term Loan \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Debt Instrument [Line Items]
Variable rate	9.00%
Variable rate, floor	2.50%

Condensed Consolidated Statements of Stockholders’ Equity - USD ($) $ in Thousands	Total	Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Preferred stock, beginning balance (in shares) at Dec. 31, 2021		6,666
Common stock, beginning balance (in shares) at Dec. 31, 2021			27,957,223
Balance at beginning of period at Dec. 31, 2021	$ 105,726		$ 28	$ 584,613	$ (478,698)	$ (217)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized gain (loss) on marketable securities	(57)					(57)
Foreign currency translation adjustment	(166)					(166)
Stock option exercises (in shares)			35,478
Stock option exercises	66			66
Stock-based compensation (in shares)			192,138
Stock-based compensation	3,028			3,028
Employee stock purchase plan shares issued (in shares)			94,226
Employee stock purchase plan shares issued	182			182
Net loss	(40,017)				(40,017)
Preferred stock, ending balance (in shares) at Mar. 31, 2022		6,666
Common stock, ending balance (in shares) at Mar. 31, 2022			28,279,065
Balance at end of period at Mar. 31, 2022	$ 68,762		$ 28	587,889	(518,715)	(440)
Preferred stock, beginning balance (in shares) at Dec. 31, 2022	6,666	6,666
Common stock, beginning balance (in shares) at Dec. 31, 2022	28,554,656		28,554,656
Balance at beginning of period at Dec. 31, 2022	$ 75,019		$ 29	594,173	(518,314)	(869)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Unrealized gain (loss) on marketable securities	12					12
Foreign currency translation adjustment	$ 59					59
Stock option exercises (in shares)	3,218		3,218
Stock option exercises	$ 4			4
Stock-based compensation (in shares)			336,206
Stock-based compensation	1,687			1,687
Employee stock purchase plan shares issued (in shares)			0
Net loss	$ (16,315)				(16,315)
Preferred stock, ending balance (in shares) at Mar. 31, 2023	6,666	6,666
Common stock, ending balance (in shares) at Mar. 31, 2023	28,894,080		28,894,080
Balance at end of period at Mar. 31, 2023	$ 60,466		$ 29	$ 595,864	$ (534,629)	$ (798)

Summary of Significant Accounting Policies - Summary of Revenue from External Customers by Geographic Areas (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation of Revenue [Line Items]
Total revenue	$ 4,170	$ 3,681
United States
Disaggregation of Revenue [Line Items]
Total revenue	2,248	2,023
Outside the United States
Disaggregation of Revenue [Line Items]
Total revenue	$ 1,922	$ 1,658

- 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.

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+ Details

Net Loss Per Common Share

3 Months Ended

Mar. 31, 2023

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, RSUs, RSAs, intended ESPP purchases and warrants because the Company's net losses would cause such shares to be anti-dilutive. Therefore, as the Company recorded net losses 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:


	Three Months Ended March 31,
		2023	2022
	(unaudited)
Shares issuable upon:
Conversion of Series A Common Equivalent Preferred Stock		6,665,841	6,665,841
Exercise of common stock warrants		4,576,505	797,487
Exercise of stock options		2,019,014	4,021,359
Vesting of RSUs and RSAs		2,653,629	1,718,351
Issuance of shares under 2020 ESPP		51,730	—
Total potentially dilutive securities		15,966,719	13,203,038

Stock-Based Compensation - Schedule of RSU Activity (Details) - Restricted Stock Units (RSUs)	3 Months Ended
	Mar. 31, 2023 $ / shares shares
Number of Shares
Unvested balance at beginning of period (in shares) \| shares	1,659,898
Granted (in shares) \| shares	1,525,000
Forfeited (in shares) \| shares	(77,720)
Vested (in shares) \| shares	(453,549)
Unvested balance at end of period (unaudited) (in shares) \| shares	2,653,629
Weighted Average Grant Price
Unvested balance at beginning of period (in dollars per share) \| $ / shares	$ 4.17
Granted (in dollars per share) \| $ / shares	1.41
Forfeited (in dollars per share) \| $ / shares	5.53
Vested (in dollars per share) \| $ / shares	2.11
Unvested balance at end of period (unaudited) (in dollars per share) \| $ / shares	$ 2.90

401(k) Retirement Plan	3 Months Ended
401(k) Retirement Plan	Mar. 31, 2023
Retirement Benefits [Abstract]
401(k) Retirement Plan	401(k) Retirement PlanThe Company has a 401(k) retirement savings plan that provides retirement benefits to substantially all full-time U.S. employees. Eligible employees may contribute a percentage of their annual compensation, subject to Internal Revenue Service limitations. The Company provided no contributions to the 401(k) retirement savings plan for the three months ended March 31, 2023 and 2022.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Lessor Sales-Type Leases (Tables)

3 Months Ended

Mar. 31, 2023

Leases [Abstract]

Estimated Future Maturities of Sales-Type Lease Receivables

The following table is an estimation of maturities of customer sales-type lease receivables for each of the following years as of March 31, 2023 (in thousands):


	Total Maturities
Nine months ending December 31, 2023	$	527
Year ending December 31, 2024	393
Year ending December 31, 2025	133
Total maturities of customer sales-type leases	$	1,053

Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Compensation and related expenses	$ 4,988	$ 6,919
Professional fees	169	126
Deferred revenue	297	326
Sales and use tax	724	639
Clinical studies	252	390
Clinician Council payable	191	216
Accrued royalties	223	159
Accrued restructuring	19	45
Other	439	866
Total accrued liabilities	$ 7,302	$ 9,686

Stock-Based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions		3 Months Ended		12 Months Ended
	Jan. 01, 2023	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022	Aug. 05, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Expected dividend yield		0.00%	0.00%
Fair value exercise price to calculate aggregate intrinsic value of options (in dollars per share)		$ 0.75		$ 1.15
Share based compensation by share based payment arrangement weighted-average grant date fair value per share of stock option grants (in dollars per share)		$ 0.94
Unrecognized compensation related to stock options not vested		$ 5.8
Share based compensation non vested award period for recognition		1 year 6 months
Restricted Stock Units (RSUs)
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based compensation non vested award period for recognition		1 year 9 months 18 days
Unrecognized compensation related to restricted stock not vested		$ 6.1
2022 Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		6,000,000
Share based payment arrangement number of shares available for issuance (in shares)		5,887,500
2020 Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		5,573,491
Share based payment arrangement number of shares available for issuance (in shares)		1,332,061
Share based compensation by share based payments arrangement, number of additional shares authorized (in shares)	1,142,186
2011 Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Share based payment arrangement, shares authorized for issuance (in shares)		1,318,865
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)		252,042			645,105
Number of shares available for purchase (in shares)		714,179
2020 ESPP \| Maximum
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Participants purchase price of common stock		85.00%

Commitments and Contingencies (Details)	Feb. 14, 2022 lawsuit
Commitments and Contingencies Disclosure [Abstract]
Number of class action lawsuits	2

Debt (Tables)

3 Months Ended

Mar. 31, 2023

Debt Disclosure [Abstract]

Summary of Outstanding Debt

Outstanding debt as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
2022 Credit Agreement(1)	$	36,750	$	36,776
Total outstanding debt, gross	36,750		36,776
Less: Unamortized debt discount and fees	(2,224)		(2,342)
Total outstanding debt, long-term	$	34,526	$	34,434

(1)The 2022 Credit Agreement includes final payment fees of $1.8 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

Accrued Liabilities (Tables)

3 Months Ended

Mar. 31, 2023

Payables and Accruals [Abstract]

Summary of Accrued Liabilities

Accrued liabilities consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Compensation and related expenses	$	4,988	$	6,919
Professional fees	169		126
Deferred revenue	297		326
Sales and use tax	724		639
Clinical studies	252		390
Clinician Council payable	191		216
Accrued royalties	223		159
Accrued restructuring	19		45
Other	439		866
Total accrued liabilities	$	7,302	$	9,686

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”) for interim financial information and the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and notes required by U.S. GAAP for complete financial statements. In the opinion of management, the condensed consolidated financial statements reflect all adjustments, which include only normal recurring adjustments necessary for the fair statement of the balances and results for the periods presented. Certain information and note disclosures normally included in the Company’s annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. These condensed consolidated financial statement results are not necessarily indicative of results to be expected for the full fiscal year or any future period.
Principles of Consolidation	Principles of Consolidation The condensed consolidated financial statements include the accounts of Acutus Medical, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates and Assumptions	Use of Estimates and Assumptions The preparation of the condensed consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, expenses and disclosures of contingent assets and liabilities. These estimates and assumptions are based on current facts, historical experience and various other factors believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities and the recording of revenue and expenses that are not readily apparent from other sources. Actual results could differ from those estimates.
Segments	Segments Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker in making decisions regarding resource allocation and assessing performance. The Company views its operations and manages its business as one operating segment and reportable segment.
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with maturities of three months or less when purchased to be cash equivalents. All of the Company’s cash equivalents have liquid markets and high credit ratings. The Company maintains its cash in bank deposits and other accounts, the balances of which, at times and as of March 31, 2023 and December 31, 2022, exceeded federally insured limits. Restricted cash consists of (i) deposited cash collateral for the Company’s corporate credit card program and (ii) cash received for the sale of business to Medtronic held in an indemnity escrow account until certain terms of sale are met.
Marketable Securities	Marketable Securities The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities and Yankee debt securities. The Company considers its debt securities to be available-for-sale securities. Available-for-sale securities are classified as cash equivalents or short-term or long-term marketable securities based on the maturity date at time of purchase and their availability to meet current operating requirements. Marketable securities that mature in three months or less from the date of purchase are classified as cash equivalents. Marketable securities, excluding cash equivalents, that mature in one year or less are classified as short-term available-for-sale securities and are reported as a component of current assets. Securities that are classified as available-for-sale are measured at fair value with temporary unrealized gains and losses reported in other comprehensive loss, and as a component of stockholders’ equity until their disposition or maturity. 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 condensed 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 condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023 and 2022.
Concentrations of Credit Risk and Off-Balance Sheet Risk	Concentrations of Credit Risk and Off-Balance Sheet RiskFinancial instruments that potentially subject the Company to credit risk consist principally of cash, cash equivalents, restricted cash, accounts receivable and marketable securities. Cash and restricted cash are maintained in accounts with financial institutions which, at times, may exceed the federal depository insurance coverage of $0.25 million. The Company has not experienced losses on these accounts, and management believes, based upon the quality of the financial institutions, that the credit risk with regard to these deposits is not significant.
Revenue from Contracts with Customers	Revenue from Contracts with Customers The Company accounts for revenue earned from contracts with customers under Accounting Standards Codification ("ASC") 606, Revenue from Contracts with Customers (“ASC 606”), and ASC 842, Leases ("ASC 842"). The core principle of ASC 606 is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The following five steps are applied to achieve that core principle: •Step 1: Identify the contract with the customer. •Step 2: Identify the performance obligations in the contract. •Step 3: Determine the transaction price. •Step 4: Allocate the transaction price to the performance obligations in the contract. •Step 5: Recognize revenue when, or as, the company satisfies a performance obligation. ASC 842 provides guidance on determining whether an agreement contains a lease. ASC 842 defines a lease as a contract, or part of a contract, that conveys the right to control the use of identified property, plant or equipment for a period of time in exchange for consideration. For new customers, the Company places its medical diagnostic equipment, the AcQMap System, at customer sites under evaluation agreements and generates revenue from the sale of disposable products used with the AcQMap System. Disposable products primarily include AcQMap catheters and AcQGuide steerable sheaths. Outside of the United States, 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. Additionally, the Company sells the AcQMap System to customers along with software updates on a when-and-if-available basis, as well as the Qubic Force Device and a transseptal crossing line of products which can be used in a variety of heart procedures and does not need to be accompanied with an AcQMap System or Qubic Force Device. Included in the transseptal crossing line of products are primarily the AcQRef Introducer Sheath, the AcQGuide Sheaths and the AcQCross Transseptal Dilator/Needle. The Company also enters into deferred equipment agreements that are generally structured such that the Company agrees to provide an AcQMap System at no up-front charge, with title of the device transferring to the customer at the end of the contract term, in exchange for the customer’s commitment to purchase disposables at a specified price over the term of the agreement, which generally ranges from two to four years. The Company has determined that such 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 is 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 AcQMap System after an evaluation. These lease agreements impose no requirement on the customer to purchase the equipment, and the equipment is not transferred to the customer at the end of the lease term. The short-term nature of the lease agreements does not result in lease payments accumulating to an amount that equals the value of the equipment nor is the lease term reflective of the economic life of the equipment. The Company’s contracts primarily include fixed consideration. Generally, there are no discounts, rebates, returns or other forms of variable consideration. Customers are generally required to pay within 30 to 60 days. The delivery of disposable products are performance obligations satisfied at a point in time. The disposable products are shipped Free on Board (“FOB”) shipping point or FOB destination. For disposable products that are shipped FOB shipping point, the customer has the significant risks and rewards of ownership and legal title to the assets when the disposable products leave the Company’s shipping facilities, and 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 include, but are not limited to, sales transactions where the specific performance obligations are sold separately, Company list prices and specific offers to customers. Except for the deferred equipment agreements noted above, the Company’s contracts with customers generally have an expected duration of one year or less, and therefore the Company has elected the practical expedient in ASC 606 to not disclose information about its remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative ("SG&A") expense as incurred due to the short duration of the Company’s contracts. The Company’s contract balances consisted solely of accounts receivable as of March 31, 2023 and December 31, 2022. In May 2020, the Company entered into bi-lateral distribution agreements (the “Bi-Lateral Distribution Agreements”) with Biotronik. Pursuant to the Bi-Lateral Distribution Agreements, the Company obtained a non-exclusive license to distribute a range of Biotronik’s products and accessories in the United States, Canada, China, Hong Kong and multiple Western European countries under the Company’s private label. Moreover, if an investigational device exemption (“IDE”) clinical trial is required for these products to obtain regulatory approval in the United States, or a clinical trial is required for these products to obtain regulatory approval in China, the Company will obtain an exclusive distribution right in such territories for a term of up to five years commencing on the date of regulatory approval if the Company covers the cost of the IDE or other clinical trial and the Company conducts such study within a specified period. Biotronik also agreed to distribute the Company’s products and accessories in Germany, Japan, Mexico, Switzerland and multiple countries in Asia-Pacific, Eastern Europe, the Middle East and South America. The Company also granted Biotronik a co-exclusive right to distribute these products in Hong Kong. Each party will pay to the other party a specified transfer price on the sale of the other party’s products and, accordingly, will earn a distribution margin on the sale of the other party’s products. In 2022, the Company sold the left-heart access transseptal crossing business to Medtronic. In connection with the sale, the Company entered into a distribution agreement (the "Distribution Agreement") with Medtronic, pursuant to which the Company acts as the original equipment manufacturer ("OEM") supplier of these products. The Company will produce and sell the products to Medtronic for a period of up to four years. Revenue is recognized when the title to the products are transferred to Medtronic, which occurs when the products are shipped from our facility (or FOB shipping point).
Inventory	Inventory Inventory is stated at the lower of cost (first-in, first-out basis) or net realizable value. The Company recorded write-downs for excess and obsolete inventory of $0.3 million and $1.0 million for the three months ended March 31, 2023 and 2022, respectively, based on management’s review of inventories on hand, comparisons to estimated future usage and sales, observed shelf-life and assumptions about the likelihood of obsolescence.
Accounts Receivable	Accounts Receivable Trade accounts receivable are recorded net of allowances for uncollectible accounts. The Company evaluates the collectability of its accounts receivable based on various factors including historical experience, the length of time the receivables are past due and the financial health of the customer. The Company reserves specific receivables if collectability is no longer reasonably assured. Based upon the assessment of these factors, the Company did not record an allowance for uncollectible accounts as of March 31, 2023 or December 31, 2022. Pursuant to the Asset Purchase Agreement with Medtronic, the Company was eligible to receive the Transfer Earnout, a contingent cash consideration of $17.0 million upon the Company’s initial submission for CE Mark certification. The Company met this condition as of December 31, 2022 and recorded a receivable on the consolidated balance sheets for the year then ended. Medtronic provided full payment in January 2023. See Note 3 - Sale of Business. In addition, beginning in February 2023, following Medtronic's first commercial sale of the left-heart access products after the Company's achievement of the OEM Earnout (as defined in Note 3 - Sale of Business, below), the Company became eligible to earn amounts equal to 100%, 75%, 50% and 50%, respectively, of quarterly Net Sales (as defined in the Asset Purchase Agreement) from sales of the left-heart access products achieved by Medtronic each year over four years. During the three months ended March 31, 2023, the Company earned $1.2 million in contingent consideration based on Medtronic's left-heart access products sales and recorded a receivable on the condensed consolidated balance sheets for the period then ended.
Employee Retention Credit Receivable	Employee Retention Credit Receivable The Employee Retention Credit is a refundable U.S. tax credit separate from tax based on income for businesses that continued to pay employees while shut down due to the COVID-19 pandemic or had significant declines in gross receipts from March 13, 2020 to December 31, 2021. The Company is an eligible employer qualifying under the program and applied for the tax credit in 2022. As of March 31, 2023, $4.2 million has been refunded to the Company, of which $2.1 million was received during the three months ended March 31, 2023. The Company expects receipt of the remaining $2.6 million receivable in 2023.
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 The Company’s intangible assets consists of a license agreement with Biotronik. The Company determines the appropriate useful life of its finite-lived intangible assets by performing an analysis of expected cash flows of the acquired assets. Finite-lived intangible assets are amortized over their estimated useful lives using the straight-line method, which approximates the pattern in which the economic benefits are consumed. Acquired in-process technology is classified as a finite-lived intangible and amortized accordingly. Indefinite-lived intangible assets are tested for impairment at least annually and are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Indefinite-lived intangible assets are impaired if their estimated fair values are less than their carrying value.
Goodwill	Goodwill Goodwill represents the excess of the purchase price of an entity over the estimated fair value of the assets acquired and liabilities assumed, and it is presented as goodwill in the accompanying condensed 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 first assesses qualitative factors to determine whether the existence of events or circumstances led to a determination that it was more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events or circumstances, it is determined that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company is required to perform the quantitative goodwill impairment test. The Company has one reporting unit. During the three months ended March 31, 2022, the Company fully impaired its goodwill balance of $12.0 million.
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 three months ended March 31, 2023 and 2022, the Company determined that there was no impairment of property and equipment or intangible assets.
Foreign Currency Translation and Transactions	Foreign Currency Translation and TransactionsThe assets, liabilities and results of operations of Acutus Medical N.V. and Acutus Medical UK Limited are measured using their functional currency, the Euro and British Pound Sterling, respectively, which is the currency of the primary foreign economic environment in which the subsidiaries operate. Upon consolidating these entities with the Company, their assets and liabilities are translated to U.S. dollars at currency exchange rates as of the balance sheet date and their 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 the entities’ financial statements are reported in accumulated other comprehensive loss in the condensed consolidated balance sheets and foreign currency translation adjustment in the condensed consolidated statements of operations and comprehensive loss.
Lessee Leases	Lease Property The Company leases office space in Carlsbad, California as its corporate headquarters and for manufacturing operations. Additionally, it leases office space in Zaventem, Belgium for international operations. The Company accounts for its lease property under ASC 842. Under this guidance, arrangements meeting the definition of a lease are classified as operating or financing leases, and are recorded on the consolidated balance sheet as both a right-of-use asset and a lease liability, calculated by discounting fixed lease payments over the lease term at the rate implicit in the lease or the Company’s incremental borrowing rate, which is the rate for collateralized borrowings based on the current economic environment, credit history, credit rating, value of leases, currency in which the lease obligation is satisfied, rate sensitivity, lease term and materiality. Lease liabilities are increased by interest and reduced by payments each period, and the right-of-use asset is amortized over the lease term. For operating leases, interest on the lease liability and the amortization of the right-of-use asset results in straight-line rent expense over the lease term. Variable lease expenses are recorded when incurred. In calculating the right-of-use asset and lease liability, the Company elected to combine lease and non-lease components. The Company adopted the policy election to exclude short-term leases having initial terms of twelve months from the initial recognition provisions of ASC 842. See Note 12 - Operating leases for additional details.
Cost of Products Sold	Cost of Products Sold Cost of products sold includes raw materials, direct labor, manufacturing overhead, shipping and receiving costs and other less significant indirect costs related to the production of the Company’s products.
Research and Development	Research and Development The Company is actively engaged in new product research and development efforts. Research and development expenses consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel directly engaged in research and development activities, clinical trial expenses, equipment costs, material costs, allocated rent and facilities costs and depreciation. Research and development expenses relating to possible future products are expensed as incurred. The Company also accrues and expenses costs for activities associated with clinical trials performed by third parties as incurred. All other costs relative to setting up clinical trial sites are expensed as incurred. Clinical trial site costs related to patient enrollment are accrued as patients are entered into the trials.
Selling, General and Administrative	Selling, General and Administrative SG&A 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 Financial Instruments Fair value measurements are based on the premise that fair value is an exit price representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the following three-tier fair value hierarchy is used in determining the inputs for measuring fair value: Level 1—Quoted prices in active markets for identical assets or liabilities. Level 2—Observable inputs other than Level 1 prices for similar assets or liabilities that are directly or indirectly observable in the marketplace. Level 3—Unobservable inputs which are supported by little or no market activity and consist of financial instruments valued using pricing models, discounted cash flow methodologies or similar techniques, as well as instruments for which the determination of fair value requires significant judgment or estimation. Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Management’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed or initial amounts recorded may not be indicative of the amount that the Company or holders of the instruments could realize in a current market exchange. There were no transfers made among the three levels in the fair value hierarchy for the three months ended March 31, 2023 and 2022. As of March 31, 2023 and December 31, 2022, the Company’s cash (excluding cash equivalents which are recorded at fair value on a recurring basis), restricted cash, accounts receivable, accounts payable and accrued expenses were carried at cost, which approximates the fair values due to the short-term nature of each instrument. The carrying amount of the Company’s long-term debt approximates fair value due to its variable market interest rate and management’s opinion that current rates and terms that would be available to the Company with the same maturity and security structure would be essentially equivalent to that of the Company’s long-term debt. The fair value of the Company’s money market securities is determined using quoted market prices in active markets for identical assets. The fair value for the available-for-sale marketable securities is determined based on valuation models using inputs that are observable either directly or indirectly (Level 2 inputs) such as quoted prices for similar assets, yield curve, volatility factors, credit spreads, default rates, loss severity, current market and contractual prices for the underlying instruments, broker and dealer quotes, as well as other relevant economic measures. Unrealized gains and losses associated with liabilities within the Level 3 category include changes in fair value that were attributable to both observable (e.g., changes in market interest rates) and unobservable (e.g., changes in unobservable long-dated volatilities) inputs. Contingent Consideration The fair value of the contingent consideration from the acquisition of Rhythm Xience, Inc. ("Rhythm Xience") in June 2019 represents the estimated fair value of future payments due to the sellers of Rhythm Xience based on the achievement of certain milestones and revenue-based targets in certain years. The initial fair value of the revenue-based contingent consideration was calculated through the use of a Monte Carlo simulation using revenue projections for the respective earn-out period, corresponding targets and approximate timing of payments as outlined in the purchase agreement. The analyses used the following assumptions: (i) expected term; (ii) risk-adjusted net sales; (iii) risk-free interest rate; and (iv) expected volatility of net sales (see table below). Estimated payments, as determined through the respective model, were further discounted by a credit spread assumption to account for credit risk. The fair value of the milestones-based contingent consideration was determined by probability weighting and discounting to the respective valuation date at the Company’s cost of debt. The Company’s cost of debt was determined by performing a synthetic credit rating for the Company and selecting yields based on companies with a similar credit rating. The contingent consideration is revalued to fair value each period on the condensed consolidated balance sheets, and any increase or decrease is recorded on the condensed consolidated statements of operations and comprehensive loss. The fair value of the contingent consideration may be impacted by certain unobservable inputs, most significantly with regard to discount rates, expected volatility and historical and projected performance. Significant changes to these inputs in isolation could result in a significantly different fair value measurement.
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 units ("RSUs"), and restricted stock awards ("RSAs"), to be recognized in the consolidated financial statements based on their respective grant date fair values. The Company estimates the fair value of stock option grants using the Black-Scholes option pricing model. The RSUs and RSAs, are valued based on the fair value of the Company’s common stock on the date of grant. The Company expenses stock-based compensation related to stock options, RSUs and RSAs over the requisite service period. All stock-based compensation costs are recorded in cost of products sold, research and development expense or SG&A expense in the condensed consolidated statements of operations and comprehensive loss based upon the respective employee’s or non-employee’s roles within the Company. Forfeitures are recorded as they occur. See Note 15—Stock-Based Compensation for additional details.
Income Taxes	Income Taxes Income taxes are recorded in accordance with ASC 740, Income Taxes (“ASC 740”), which provides for deferred taxes using an asset and liability approach. The Company recognizes deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements or tax returns. Deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse, and net operating loss (“NOL”) carryforwards and research and development 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 Liability The Company accounts for certain common stock warrants outstanding as a liability at fair value, determined using the Black-Scholes option pricing model, on the consolidated balance sheets in accordance with ASC 815, Derivatives and Hedging (“ASC 815”). The liability is subject to re-measurement at each reporting period and any change in fair value is recognized in the condensed consolidated statements of operations and comprehensive loss. See Note 13—Warrants for additional details.
Business Combinations	Business CombinationsThe Company accounts for business acquisitions using the acquisition method of accounting based on ASC 805, Business Combinations (“ASC 805”), which requires recognition and measurement of all identifiable assets acquired and liabilities assumed at their fair value as of the date control is obtained. The Company determines the fair value of assets acquired and liabilities assumed based upon its best estimates of the acquisition-date fair value of assets acquired and liabilities assumed in the acquisition. Goodwill is calculated as the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326) ("ASU 2016-13"). ASU 2016-13 sets forth a “current expected credit loss” model which requires the Company to measure all expected credit losses for financial instruments held at the reporting date based on historical experience, current conditions and reasonable supportable forecasts. This replaces the existing incurred loss model and is applicable to the measurement of credit losses on financial assets measured at amortized cost, available-for-sale debt securities and applies to certain off-balance sheet credit exposures. ASU 2016-13 is effective for smaller reporting companies in 2023. The Company adopted the guidance in the first quarter of 2023 with no material impact on the condensed consolidated financial statements.

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Assets included in:
Available-for-sale securities	$ 46,839	$ 44,863
Total fair value	67,050	67,563
Liabilities included in:
Total fair value	3,900	5,146
Warrant liability
Liabilities included in:
Total fair value	1,900	3,346
Contingent consideration
Liabilities included in:
Total fair value	2,000	1,800
Money market securities
Assets included in:
Money market securities	20,211	22,700
U.S. treasury securities
Assets included in:
Available-for-sale securities	21,814	26,897
Commercial paper
Assets included in:
Available-for-sale securities	21,806	14,764
Yankee debt securities
Assets included in:
Available-for-sale securities	3,219	3,202
Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets included in:
Total fair value	20,211	22,700
Liabilities included in:
Total fair value	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Warrant liability
Liabilities included in:
Total fair value	0	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	20,211	22,700
Quoted Prices in Active Markets for Identical Assets (Level 1) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Commercial paper
Assets included in:
Available-for-sale securities	0	0
Quoted Prices in Active Markets for Identical Assets (Level 1) \| Yankee debt securities
Assets included in:
Available-for-sale securities	0	0
Significant Other Observable Inputs (Level 2)
Assets included in:
Total fair value	46,839	44,863
Liabilities included in:
Total fair value	0	0
Significant Other Observable Inputs (Level 2) \| Warrant liability
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) \| U.S. treasury securities
Assets included in:
Available-for-sale securities	21,814	26,897
Significant Other Observable Inputs (Level 2) \| Commercial paper
Assets included in:
Available-for-sale securities	21,806	14,764
Significant Other Observable Inputs (Level 2) \| Yankee debt securities
Assets included in:
Available-for-sale securities	3,219	3,202
Significant Unobservable Inputs (Level 3)
Assets included in:
Total fair value	0	0
Liabilities included in:
Total fair value	3,900	5,146
Significant Unobservable Inputs (Level 3) \| Warrant liability
Liabilities included in:
Total fair value	1,900	3,346
Significant Unobservable Inputs (Level 3) \| Contingent consideration
Liabilities included in:
Total fair value	2,000	1,800
Significant Unobservable Inputs (Level 3) \| Money market securities
Assets included in:
Money market 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	$ 0

Inventory (Tables)

3 Months Ended

Mar. 31, 2023

Inventory Disclosure [Abstract]

Summary of Inventory

Inventory as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Raw materials	$	10,253	$	9,179
Work in process	1,843		2,025
Finished goods	2,842		2,123
Total inventory	$	14,938	$	13,327

Summary of Significant Accounting Policies - Summary of Cash and Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022	Mar. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Cash and cash equivalents	$ 22,738	$ 25,584
Restricted Cash	7,139	5,764
Total cash, cash equivalents and restricted cash	$ 29,877	$ 31,348	$ 12,469	$ 24,221

Stock-Based Compensation (Tables)

3 Months Ended

Mar. 31, 2023

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 options for the three months ended March 31, 2023 and 2022:


	Three Months Ended March 31,
	2023	2022
	(unaudited)
Risk-free interest rate	4.27%	1.76%
Expected dividend yield	—	—
Expected term in years	5.6	6.0
Expected volatility	75%	75%

Summary of Stock Option Activity

The Company's stock option activity for the three months ended March 31, 2023 was as follows:


	Stock Options	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2022	2,898,821	$	6.83	6.9	$	79
Options granted	592,500	1.41
Options exercised	(3,218)	1.34			$	1
Options forfeited	(35,224)	2.10
Outstanding as of March 31, 2023 (unaudited)	3,452,879	$	5.96	7.2	$	29
Options vested and exercisable as of March 31, 2023 (unaudited)	2,019,014	$	7.88	5.9	$	—

Schedule of RSU Activity

The Company’s RSU activity for the three months ended March 31, 2023 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2022	1,659,898	$	4.17
Granted	1,525,000	1.41
Forfeited	(77,720)	5.53
Vested	(453,549)	2.11
Unvested as of March 31, 2023 (unaudited)	2,653,629	$	2.90

Summary of the Total Stock-Based Compensation Expense for the Stock Options, PSUs and RSAs Recorded in the Condensed Consolidated Statements of Operations and Comprehensive Loss

The following table summarizes the total stock-based compensation expense for the stock options, PSUs, RSUs, RSAs and ESPP expense recorded in the condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Cost of products sold	$	74	$	226
Research and development	346		514
Selling, general and administrative	1,484		2,292
Total stock-based compensation	$	1,904	$	3,032

Warrants

3 Months Ended

Mar. 31, 2023

Warrants and Rights Note Disclosure [Abstract]

Warrants

As of March 31, 2023 and December 31, 2022, the outstanding warrants to purchase the Company’s common stock consisted of the following:


	Exercise Price		Expiration Date	March 31, 2023	December 31, 2022
				(unaudited)
Warrants issued in 2015	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	$	0.10	6/7/28	346,689	346,689
Warrants issued with 2018 Term Loan	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	$	16.67	5/20/29	419,992	419,992
Warrants issued with 2022 Credit Agreement	$	1.11	6/30/30	3,779,018	3,779,018
Total Warrants				4,576,505	4,576,505

There was no warrant activity during the three months ended March 31, 2023.

The Company’s warrants provide the holder the option to purchase a specified number of shares for a specified price within a specified duration or upon the occurrence of a specific event. The holder may exercise the warrant either by cash payment or by exercise pursuant to a cashless exercise whereby a calculated number of shares are withheld upon exercise to satisfy the exercise price. The warrants do not provide the holder any voting rights until the warrants are exercised.

In accordance with ASC 480, the 2022 Warrants are recorded at fair value on the condensed consolidated balance sheets as a warrant liability. Changes in fair value are recognized as a change in fair value of warrant liability in the condensed consolidated statements of operations and comprehensive loss. For the three months ended March 31, 2023, a favorable fair value change of $1.4 million was recognized.

In connection with the Series A Common Equivalent Preferred Stock Exchange Agreements (as defined below), 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.

Property and Equipment, Net - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 1,297	$ 1,567

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 22,738	$ 25,584
Marketable securities, short-term	46,839	44,863
Restricted cash, short-term	7,139	5,764
Accounts receivable	5,340	21,085
Inventory	14,938	13,327
Employer retention credit receivable	2,562	4,703
Prepaid expenses and other current assets	2,232	2,541
Total current assets	101,788	117,867
Noncurrent assets
Property and equipment, net	8,145	9,221
Right-of-use assets, net	3,708	3,872
Intangible assets, net	1,533	1,583
Other assets	822	897
Total assets	115,996	133,440
Current liabilities:
Accounts payable	5,569	4,721
Accrued liabilities	7,302	9,686
Contingent consideration, short-term	2,000	1,800
Operating lease liabilities, short-term	339	319
Warrant liability	1,900	3,346
Total current liabilities	17,110	19,872
Operating lease liabilities, long-term	3,883	4,103
Long-term debt	34,526	34,434
Other long-term liabilities	11	12
Total liabilities	55,530	58,421
Commitments and contingencies (Note 12)
Stockholders' equity
Preferred stock, $0.001 par value; 5,000,000 shares authorized as of March 31, 2023 and December 31, 2022; 6,666 shares of the preferred stock, designated as Series A Common Equivalent Preferred Stock, are issued and outstanding as of March 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; 260,000,000 shares authorized as of March 31, 2023 and December 31, 2022; 28,894,080 and 28,554,656 shares issued and outstanding as of March 31, 2023 and December 31, 2022, respectively	29	29
Additional paid-in capital	595,864	594,173
Accumulated deficit	(534,629)	(518,314)
Accumulated other comprehensive loss	(798)	(869)
Total stockholders' equity	60,466	75,019
Total liabilities and stockholders' equity	$ 115,996	$ 133,440

Sale of Business (Tables)

3 Months Ended

Mar. 31, 2023

Discontinued Operations and Disposal Groups [Abstract]

Summary of Sale of Discontinued Operation

The Company recorded the following amounts for the three months ended March 31, 2023, resulting in a net gain of $1.2 million related to the sale of business to Medtronic, calculated as the difference between the non-contingent consideration earned, less direct transaction costs (in thousands):


	Three Months Ended March 31, 2023
	(unaudited)
Percentage of Product Net Sales Earnout accrued as of March 31, 2023	$	1,244
Transaction costs	(37)
Gain on sale of business, net	$	1,207

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

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+ Details

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities
Net loss	$ (16,315)	$ (40,017)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation expense	1,297	1,567
Amortization of intangible assets	50	160
Non-cash stock-based compensation expense	1,904	3,032
(Accretion of discounts) amortization of premiums on marketable securities, net	(527)	173
Amortization of debt issuance costs	104	378
Amortization of operating lease right-of-use assets	164	160
Goodwill impairment	0	12,026
Gain on sale of business, net	(1,207)	0
Change in fair value of warrant liability	(1,446)	0
Loss on disposal of property and equipment	38	0
Change in fair value of contingent consideration	200	7
Changes in operating assets and liabilities:
Accounts receivable	(11)	655
Inventory	(1,611)	(1,212)
Employer retention credit receivable	2,141	0
Prepaid expenses and other current assets	391	(3,487)
Other assets	75	120
Accounts payable	873	(2,641)
Accrued liabilities	(2,433)	1,532
Operating lease liabilities	(201)	(14)
Other long-term liabilities	(1)	(48)
Net cash used in operating activities	(16,515)	(27,609)
Cash flows from investing activities
Proceeds from sale of business	17,000	0
Purchases of available-for-sale marketable securities	(28,019)	0
Sales of available-for-sale marketable securities	0	2,500
Maturities of available-for-sale marketable securities	26,500	14,587
Purchases of property and equipment	(232)	(1,088)
Net cash provided by investing activities	15,249	15,999
Cash flows from financing activities
Proceeds from the exercise of stock options	4	66
Repurchase of common shares to pay employee withholding taxes	(217)	0
Proceeds from employee stock purchase plan	0	182
Payment of contingent consideration	0	(290)
Net cash used in financing activities	(213)	(42)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	8	(100)
Net change in cash, cash equivalents and restricted cash	(1,471)	(11,752)
Cash, cash equivalents and restricted cash, at the beginning of the period	31,348	24,221
Cash, cash equivalents and restricted cash, at the end of the period	29,877	12,469
Supplemental disclosure of cash flow information:
Cash paid for interest	1,207	1,025
Supplemental disclosure of noncash investing and financing activities:
Accounts receivable from sale of business	1,244	0
Change in unrealized (gain) loss on marketable securities	(12)	57
Change in unpaid purchases of property and equipment	(25)	(97)
Contingent consideration escrow release	$ 0	$ 17

Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 50	$ 160

Marketable Securities

3 Months Ended

Mar. 31, 2023

Investments, Debt and Equity Securities [Abstract]

Marketable Securities

Marketable securities consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023 (unaudited)
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
U.S. treasury securities	$	21,809	$	5	$	—	$	21,814
Commercial paper	21,806		—		—		21,806
Yankee debt securities	3,220		—		(1)		3,219
Total available-for-sale securities - short-term	46,835		5		(1)		46,839
Total available-for-sale securities	$	46,835	$	5	$	(1)	$	46,839


	December 31, 2022
	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses		Fair Value
Available-for-sale securities - short-term:
U.S. treasury securities	$	26,906	$	3	$	(12)	$	26,897
Commercial paper	3,200		2		—		3,202
Yankee debt securities	14,764		—		—		14,764
Total available-for-sale securities - short-term	44,870		5		(12)		44,863
Total available-for-sale securities	$	44,870	$	5	$	(12)	$	44,863

As of March 31, 2023, the Company’s available-for-sale securities classified as short-term of $46.8 million mature in 1 year or less and there were none held long-term. As of December 31, 2022, the Company’s available-for-sale securities classified as short-term of $44.9 million mature in 1 year or less and there were none held long-term.

Operating Leases - Narrative (Details)	Mar. 31, 2023 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

Related Party Transactions (Details) - USD ($) $ / shares in Units, $ in Millions		3 Months Ended		12 Months Ended
	Jun. 30, 2022	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	May 20, 2019
Related Party Transaction [Line Items]
Common stock, shares issued (in shares)		28,894,080		28,554,656
Vesting of RSUs and RSAs
Related Party Transaction [Line Items]
Common stock, shares issued (in shares)	3,779,018
Class of warrants, exercise price (in dollars per share)	$ 1.1114
Warrant, term	8 years
2019 Credit Agreement
Related Party Transaction [Line Items]
Line of credit cumulative drawdowns till date	$ 40.0			$ 34.4	$ 40.4
2019 Credit Agreement \| Senior Term Loan
Related Party Transaction [Line Items]
Face amount						$ 70.0
2022 Amended Credit Agreement \| Senior Term Loan
Related Party Transaction [Line Items]
Face amount	$ 35.0
Orbimed Royalty Oppurtunities Two LP and Deerfield Private Design Fund LP \| 2019 Credit Agreement
Related Party Transaction [Line Items]
Interest expenses related party				$ 5.1	$ 5.7
Maximum \| Selling, general and administrative \| Consulting Agreement \| Director and the Chairman
Related Party Transaction [Line Items]
Consulting fees incurred for related party		$ 0.1	$ 0.1

Property and Equipment, Net - Summary of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 24,840	$ 24,708
Less: accumulated depreciation	(16,695)	(15,487)
Property and equipment, net	8,145	9,221
Medical diagnostic equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	15,042	14,826
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment	400	432
Office equipment
Property, Plant and Equipment [Line Items]
Total property and equipment	1,556	1,556
Laboratory equipment and software
Property, Plant and Equipment [Line Items]
Total property and equipment	5,226	5,148
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment	608	580
Construction in process
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 2,008	$ 2,166

Lessor Sales-Type Leases - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Lessor, Lease, Description [Line Items]
Lease revenue	$ 0.0	$ 0.0
Prepaid Expenses and Other Current Assets
Lessor, Lease, Description [Line Items]
Lease receivable	0.6		$ 0.6
Other Assets
Lessor, Lease, Description [Line Items]
Lease receivable	$ 0.4		$ 0.5

Net Loss Per Common Share (Tables)

3 Months Ended

Mar. 31, 2023

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:


	Three Months Ended March 31,
		2023	2022
	(unaudited)
Shares issuable upon:
Conversion of Series A Common Equivalent Preferred Stock		6,665,841	6,665,841
Exercise of common stock warrants		4,576,505	797,487
Exercise of stock options		2,019,014	4,021,359
Vesting of RSUs and RSAs		2,653,629	1,718,351
Issuance of shares under 2020 ESPP		51,730	—
Total potentially dilutive securities		15,966,719	13,203,038

Intangible Assets - Summary of Goodwill and Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Intangible Assets
Balance at beginning of period	$ 1,583
Amortization expense	(50)	$ (160)
Balance at end of period (unaudited)	$ 1,533

Cover Page - shares	3 Months Ended
Cover Page - shares	Mar. 31, 2023	May 08, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2023
Document Transition Report	false
Entity File Number	001-39430
Entity Registrant Name	ACUTUS MEDICAL, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	45-1306615
Entity Address, Address Line One	2210 Faraday Ave.
Entity Address, Address Line Two	Suite 100,
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	442
Local Phone Number	232-6080
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	AFIB
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		28,975,677
Amendment Flag	false
Document Fiscal Period Focus	Q1
Entity Central Index Key	0001522860
Document Fiscal Year Focus	2023
Current Fiscal Year End Date	--12-31

Summary of Significant Accounting Policies - Summary of Weighted-Average Fair Value Assumptions on Contingent Consideration (Details) - Significant Unobservable Inputs (Level 3) - Rhythm Xience	Mar. 31, 2023 year	Dec. 31, 2022 year
Risk-free interest rate
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent consideration from the acquisition, fair value inputs	0.0500	0.0480
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	0.234	0.280

Debt

3 Months Ended

Mar. 31, 2023

Debt Disclosure [Abstract]

Debt

Outstanding debt as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
2022 Credit Agreement(1)	$	36,750	$	36,776
Total outstanding debt, gross	36,750		36,776
Less: Unamortized debt discount and fees	(2,224)		(2,342)
Total outstanding debt, long-term	$	34,526	$	34,434

(1)The 2022 Credit Agreement includes final payment fees of $1.8 million.

2022 Amended and Restated Credit Agreement

On June 30, 2022, the Company amended and restated its prior debt facility. The amended and restated credit agreement (the "2022 Credit Agreement") is with new lenders consisting of certain affiliates of Deerfield Management Company (collectively referred to as “Deerfield”) and is for an aggregate principal amount of $35.0 million and has a 5-year term. Proceeds from the 2022 Credit Agreement, along with cash on hand, were used to repay the prior debt facility and to pay related fees and expenses.

The 2022 Credit Agreement bears an annual interest of 9% plus the one-month adjusted term Secured Overnight Financing Rate (applying a 2.5% minimum rate). From date of closing, amortization payments are due as follows:

•15% of the principal due at the end of month 36;

•15% of the principal due at the end of month 48; and

•70% due at the end of month 60.

The 2022 Credit Agreement is subject to prepayment penalties. The 2022 Credit Agreement provides for final payment fees of an additional $1.8 million due upon prepayment, on the maturity date or upon acceleration.

The 2022 Credit Agreement is secured by a first-priority perfected lien on and security interest in substantially all of the Company’s existing and after-acquired tangible and intangible assets, subject to certain exceptions noted in the 2022 Credit Agreement.

The 2022 Credit Agreement is subject to certain customary affirmative covenants, representations and warranties and other terms and conditions. It also contains certain customary negative covenants, including, but not limited to, restrictions on the Company’s ability and that of its subsidiaries to merge and consolidate with other companies, incur indebtedness, grant liens or security interests on assets, pay dividends or make other restricted payments, sell or otherwise transfer assets or enter into transactions with affiliates. As of and for the three months ended March 31, 2023, the Company was in compliance with all such covenants.

In addition, the 2022 Credit Agreement includes customary events of default and other provisions that could require all amounts due thereunder to become immediately due and payable, either automatically or at the option of the lenders, if the Company fails to comply with the terms.

In connection with entering into the 2022 Credit Agreement, the Company entered into a warrant purchase agreement (the "2022 Warrant Purchase Agreement") with Deerfield, pursuant to which the Company issued to Deerfield warrants to purchase up to an aggregate 3,779,018 shares of common stock at an exercise price of $1.1114 per warrant share for a period of eight years following issuance (the "2022 Warrants").

The 2022 Warrants represent a freestanding financial instrument and are conditionally puttable at the holder’s option upon an event that is outside of the Company’s control. Therefore, the 2022 Warrants are classified as liability pursuant to ASC 480, Distinguishing Liabilities from Equity, initially and subsequently recognized at fair value, with changes in fair value recognized in the statement of operations and comprehensive loss. Refer to Fair Value Measurements in Note 2 - Summary of Significant Accounting Policies and Note 13 - Warrants for more information.

- 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.

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-Paragraph 1I
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Warrants - Narrative (Details) $ in Millions	3 Months Ended
Warrants - Narrative (Details) $ in Millions	Mar. 31, 2023 USD ($) holder
Warrants and Rights Note Disclosure [Abstract]
Favorable change in fair value of warrants \| $	$ 1.4
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

Net Loss Per Common Share - Summary of Calculation of the Diluted Net Loss per Common Share (Details) - shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	15,966,719	13,203,038
Conversion of Series A Common Equivalent Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	6,665,841	6,665,841
Exercise of stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	2,019,014	4,021,359
Vesting of RSUs and RSAs
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	4,576,505	797,487
Issuance of shares under 2020 ESPP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	2,653,629	1,718,351
Issuance of Stock, ESPP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares issuable (in shares)	51,730	0

Operating Leases

3 Months Ended

Mar. 31, 2023

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 non-cancelable operating lease that expires on December 31, 2027. The lease is subject to variable charges for common area maintenance and other costs that are determined annually based on actual costs. The base rent is subject to an annual increase each year. The Company has a renewal option for an additional five-year term upon the expiration date of the lease, which has been excluded from the calculation of the right-of-use asset as it is not reasonably certain to be exercised.

Additionally, the Company leases approximately 3,900 square feet of office space in Zaventem, Belgium under a non-cancelable operating lease that expires on December 31, 2024. The lease is subject to variable charges that are determined annually for common area maintenance and other costs based on actual costs, and base rent is subject to an annual increase each year based on an index rate.

The following table summarizes quantitative information about the Company’s operating leases for the three months ended March 31, 2023 and 2022 (dollars in thousands):


	Three Months Ended March 31,
	2023			2022
	(unaudited)
Operating cash flows from operating leases	$	281		$	98

Weighted average remaining lease term – operating leases (in years)	4.7			3.4
Weighted average discount rate – operating leases	7.0		%	7.0		%

The following table provides the components of the Company’s operating lease expense for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Operating leases
Operating lease cost	$	251	$	247
Variable lease cost	81		77
Total operating lease expense	$	332	$	324

As of March 31, 2023, future minimum payments under the non-cancelable operating leases under ASC 842 were as follows (in thousands):


Nine months ending December 31, 2023	$	330
Year ending December 31, 2024	1,159
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Year ending December 31, 2027	1,221
Total	5,046
Less: present value discount	(824)
Operating lease liabilities	$	4,222

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	6,666	6,666
Preferred stock, shares outstanding (in shares)	6,666	6,666
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	260,000,000	260,000,000
Common stock, shares issued (in shares)	28,894,080	28,554,656
Common stock, shares outstanding (in shares)	28,894,080	28,554,656

Lessor Sales-Type Leases

3 Months Ended

Mar. 31, 2023

Leases [Abstract]

Lessor Sales-Type Leases

The Company recognizes revenue and costs, as well as a lease receivable, at the commencement of embedded sales-type leases within its deferred equipment agreements. There was no lease revenue related to sales-type leases for both the three months ended March 31, 2023 and 2022. Costs related to embedded leases within the Company’s deferred equipment agreements are included in cost of products sold in the condensed consolidated statements of operations and comprehensive loss.

As of March 31, 2023 and December 31, 2022, a balance of $0.6 million for both periods for short-term leases receivable is recorded in prepaid expenses and other current assets on the condensed consolidated balance sheets, and a balance of $0.4 million and $0.5 million, respectively, for long-term leases receivable is recorded in other assets related to sales-type leases.

The following table is an estimation of maturities of customer sales-type lease receivables for each of the following years as of March 31, 2023 (in thousands):


	Total Maturities
Nine months ending December 31, 2023	$	527
Year ending December 31, 2024	393
Year ending December 31, 2025	133
Total maturities of customer sales-type leases	$	1,053

Accrued Liabilities

3 Months Ended

Mar. 31, 2023

Payables and Accruals [Abstract]

Accrued Liabilities

Accrued liabilities consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Compensation and related expenses	$	4,988	$	6,919
Professional fees	169		126
Deferred revenue	297		326
Sales and use tax	724		639
Clinical studies	252		390
Clinician Council payable	191		216
Accrued royalties	223		159
Accrued restructuring	19		45
Other	439		866
Total accrued liabilities	$	7,302	$	9,686

Summary of Significant Accounting Policies - Summary of Accounts Receivable (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 5,340	$ 21,085
Trade accounts receivable
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	4,096	4,085
Earnouts receivable from Medtronic
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 1,244	$ 17,000

Stockholders’ Equity (Details) $ / shares in Units, $ in Thousands	1 Months Ended	3 Months Ended
	Aug. 31, 2021 investor $ / shares shares	Mar. 31, 2023 USD ($) $ / shares shares	Mar. 31, 2022 USD ($) shares	Dec. 31, 2022 $ / 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
Stock option exercises (in shares)		3,218
Proceeds from the exercise of stock options \| $		$ 4	$ 66
Employee stock purchase plan shares issued \| $			$ 182
Maximum
Class of Stock [Line Items]
Proceeds from the exercise of stock options \| $		$ 100
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Restricted share award shares issued (in shares)		336,206	192,138
Common Stock
Class of Stock [Line Items]
Stock option exercises (in shares)		3,218	35,478
Employee stock purchase plan shares issued (in shares)		0	94,226
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

Sale of Business - Summary of Sale of Discontinued Operation (Details) - Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations - Left-Heart Access Portfolio - Medtronic - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Percentage of Product Net Sales Earnout accrued as of March 31, 2023	$ 1,244
Transaction costs	37
Gain on sale of business, net	$ 1,207	$ 79,500

401(k) Retirement Plan (Details) - USD ($)	3 Months Ended
401(k) Retirement Plan (Details) - USD ($)	Mar. 31, 2023	Mar. 31, 2022
401(k) Retirement Plan
Defined Contribution Plan Disclosure [Line Items]
Employer contribution to defined benefit plan	$ 0	$ 0

Warrants (Tables)

3 Months Ended

Mar. 31, 2023

Warrants and Rights Note Disclosure [Abstract]

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

The fair value was estimated to be $0.5026 per warrant as of March 31, 2023 and the significant inputs used in the estimation of the fair value were as follows:


			March 31, 2023
			(unaudited)
Risk-free interest rate			3.55%
Expected term in years			7.25
Expected volatility			75.0%

As of March 31, 2023 and December 31, 2022, the outstanding warrants to purchase the Company’s common stock consisted of the following:


	Exercise Price		Expiration Date	March 31, 2023	December 31, 2022
				(unaudited)
Warrants issued in 2015	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	$	0.10	6/7/28	346,689	346,689
Warrants issued with 2018 Term Loan	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	$	16.67	5/20/29	419,992	419,992
Warrants issued with 2022 Credit Agreement	$	1.11	6/30/30	3,779,018	3,779,018
Total Warrants				4,576,505	4,576,505

Lessor Sales-Type Leases - Estimated Future Maturities of Sales-Type Lease Receivables (Details) $ in Thousands	Mar. 31, 2023 USD ($)
Leases [Abstract]
Nine months ending December 31, 2023	$ 527
Year ending December 31, 2024	393
Year ending December 31, 2025	133
Total maturities of customer sales-type leases	$ 1,053

Organization and Description of Business	3 Months Ended
Organization and Description of Business	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Description of Business	Organization and Description of Business Acutus Medical, Inc. (the “Company”) is an arrhythmia management company focused on improving the way cardiac arrhythmias are diagnosed and treated. The Company designs, manufactures and markets a range of tools for catheter-based ablation procedures to treat various arrhythmias. The Company’s product portfolio includes novel access sheaths, diagnostic and mapping catheters, ablation catheters, mapping and imaging consoles and accessories, as well as supporting algorithms and software programs. The Company was incorporated in the state of Delaware on March 25, 2011, and is located in Carlsbad, California. Liquidity, Capital Resources and Going Concern 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 March 31, 2023 and December 31, 2022, the Company had cash, cash equivalents, restricted cash and marketable securities of $76.7 million and $76.2 million, respectively. For the three months ended March 31, 2023 and 2022, net losses were $16.3 million and $40.0 million, respectively, and net cash used in operating activities was $16.5 million and $27.6 million, respectively. As of March 31, 2023 and December 31, 2022, the Company had an accumulated deficit of $534.6 million and $518.3 million, respectively, and working capital of $84.7 million and $98.0 million, respectively. Since raising $166.3 million from its IPO in August 2020, the Company has issued additional shares of common stock. From time to time, the Company's Board of Directors issues common stock for its stock-based compensation plans and for its ESPP. Additionally, in July 2021, the Company issued 6,325,000 shares of common stock in a public offering, which included 825,000 shares of common stock issued upon the underwriter’s exercise in full of an option to purchase additional shares of common stock. The price to the public for each share was $14.00. The Company received gross proceeds of $88.6 million from the offering. Net of underwriting discounts and commission and other offering expenses, the Company received proceeds of $82.7 million. On June 30, 2022, Medtronic, Inc. (“Medtronic”) paid the Company $50.0 million at the first closing (the "First Closing") of the sale of the Company's left-heart access portfolio to Medtronic, of which $4.0 million was paid into an indemnity escrow account for a period of 18 months following the First Closing to secure the Company's indemnification obligations under the asset purchase agreement ("Asset Purchase Agreement") entered into with Medtronic on April 26, 2022. The OEM Earnout (as defined in Note 3 - Sale of Business, below) under the Asset Purchase Agreement with Medtronic was achieved on October 31, 2022, with $20.0 million paid by Medtronic to the Company in November 2022. Additionally, the Transfer Earnout (as defined in Note 3 - Sale of Business, below) under the Asset Purchase Agreement with Medtronic was achieved on December 21, 2022, with $17.0 million paid by Medtronic to the Company in January 2023. Beginning in February 2023, following Medtronic's first commercial sale of the left-heart access products after the Company's achievement of the OEM Earnout (as defined in Note 3 - Sale of Business, below), the Company became eligible to earn amounts equal to 100%, 75%, 50% and 50%, respectively, of quarterly Net Sales (as defined in the Asset Purchase Agreement) from sales of the left-heart access products achieved by Medtronic each year over four years. During the three months ended March 31, 2023, the Company earned $1.2 million in contingent consideration based on Medtronic's left-heart access products sales. Management believes the Company’s current cash, cash equivalents and marketable securities are sufficient to fund operations for at least the next 12 months from the date of this filing. To ensure that the Company has sufficient resources to fund operations, management continues to review cost improvement opportunities and pathways to reduce expenses and cash burn, while preserving the resources to invest in future growth. In the future, the Company may need to raise additional funds through one or more of the following: 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 - Narrative (Details)			1 Months Ended	3 Months Ended
	Jan. 13, 2023 USD ($)	Jun. 30, 2022 USD ($)	Nov. 30, 2022 USD ($)	Mar. 31, 2023 USD ($) segment reporting_unit	Mar. 31, 2022 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of operating segment \| segment				1
Number of reportable segments \| segment				1
Other-than-temporary impairments related to marketable securities				$ 0	$ 0
Cash, FDIC insured amount				250,000
Inventory write-down				300,000	1,000,000
Allowance for uncollectible accounts				0			$ 0
Proceeds from sale of business				17,000,000	0
Employer retention credit receivable				$ 2,562,000			4,703,000
Number of reporting unit \| reporting_unit				1
Goodwill impairment				$ 0	12,026,000
Impairment of property and equipment				0	0
Impairment of intangible assets				0	0
Research and development				(6,117,000)	(8,003,000)
Selling, general and administrative				(9,565,000)	$ (14,385,000)
Prepaid expenses and other current assets				2,232,000			$ 2,541,000
Left-Heart Access Portfolio
Summary Of Significant Accounting Policies [Line Items]
Contingent consideration received from sales				1,200,000
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Summary Of Significant Accounting Policies [Line Items]
Proceeds from sale of business	$ 17,000,000	$ 50,000,000	$ 20,000,000
CARES Employee Retention Credit
Summary Of Significant Accounting Policies [Line Items]
Employer retention credit, amount refunded				4,200,000
Employer retention credit receivable				$ 2,100,000
CARES Employee Retention Credit \| Forecast
Summary Of Significant Accounting Policies [Line Items]
Employer retention credit receivable						$ 2,600,000
Minimum
Summary Of Significant Accounting Policies [Line Items]
Customers payment period				30 days
Property and equipment, estimated useful lives				3 years
Maximum
Summary Of Significant Accounting Policies [Line Items]
Customers payment period				60 days
Contracts with customers, expected duration				1 year
Agreement to produce and sell products, term				4 years
Property and equipment, estimated useful lives				5 years
Deferred Equipment Agreements \| Minimum
Summary Of Significant Accounting Policies [Line Items]
Term of contract				2 years
Deferred Equipment Agreements \| Maximum
Summary Of Significant Accounting Policies [Line Items]
Term of contract				4 years

Intangible Assets

3 Months Ended

Mar. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets

The following table presents intangible assets activity for the three months ended March 31, 2023 (in thousands):


	Intangible Assets
Balance, December 31, 2022	$	1,583
Amortization expense	(50)
Balance, March 31, 2023 (unaudited)	$	1,533

Intangible Assets

The tables below present the details of intangible assets as of March 31, 2023 and December 31, 2022 (dollars in thousands):


March 31, 2023	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		Balance
							(unaudited)


Licensed intangibles	10.0	7.7	$	2,000	$	(467)	$	1,533
Total intangible assets			$	2,000	$	(467)	$	1,533


December 31, 2022	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets			Accumulated Amortization		Balance
Licensed intangibles	10.0	7.9	2,000			(417)		1,583
Total intangible assets			$	2,000	Rx	$	(417)	$	1,583

The Company recorded amortization expense related to the above intangible assets of $0.1 million and $0.2 million for the three months ended March 31, 2023 and 2022, respectively.

The following table presents the future amortization expense associated with amortizable intangible assets as of March 31, 2023 (in thousands):


	Total Amortization
Nine months ending December 31, 2023	$	150
Year ending December 31, 2024	200
Year ending December 31, 2025	200
Year ending December 31, 2026	200
Year ending December 31, 2027	200
Thereafter	583
Total future amortization	$	1,533

Marketable Securities - Summary of Marketable Securities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Available-for-sale securities - short-term:
Amortized Cost	$ 46,835	$ 44,870
Gross Unrealized Gains	5	5
Gross Unrealized Losses	(1)	(12)
Fair Value	46,839	44,863
Total available-for-sale securities
Amortized Cost	46,835	44,870
Gross Unrealized Gains	5	5
Gross Unrealized Losses	(1)	(12)
Fair Value	46,839	44,863
U.S. treasury securities
Available-for-sale securities - short-term:
Amortized Cost	21,809	26,906
Gross Unrealized Gains	5	3
Gross Unrealized Losses	0	(12)
Fair Value	21,814	26,897
Commercial paper
Available-for-sale securities - short-term:
Amortized Cost	21,806	3,200
Gross Unrealized Gains	0	2
Gross Unrealized Losses	0	0
Fair Value	21,806	3,202
Yankee debt securities
Available-for-sale securities - short-term:
Amortized Cost	3,220	14,764
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(1)	0
Fair Value	$ 3,219	$ 14,764

Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2023

Accounting Policies [Abstract]

Summary of Cash and Cash Equivalents and Restricted Cash

The following table reconciles cash, cash equivalents and restricted cash in the condensed consolidated balance sheets to the total balances as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Cash and cash equivalents	$	22,738	$	25,584
Restricted cash	7,139		5,764
Total cash, cash equivalents and restricted cash	$	29,877	$	31,348

Summary of Cash and Cash Equivalents and Restricted Cash

The following table reconciles cash, cash equivalents and restricted cash in the condensed consolidated balance sheets to the total balances as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Cash and cash equivalents	$	22,738	$	25,584
Restricted cash	7,139		5,764
Total cash, cash equivalents and restricted cash	$	29,877	$	31,348

Summary of Disaggregation of Revenue

The following table sets forth the Company’s revenue for disposables, systems and service/other for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Disposables	$	3,426	$	3,211
Systems	—		—
Service/Other	744		470
Total revenue	$	4,170	$	3,681

Summary of Revenue from External Customers by Geographic Areas

The following table provides revenue by geographic location for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
United States	$	2,248	$	2,023
Outside the United States	1,922		1,658
Total revenue	$	4,170	$	3,681

Schedule of Accounts, Notes, Loans and Financing Receivable

Accounts receivable recorded on the condensed consolidated balance sheets as of March 31, 2023 and December 31, 2022 consists of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Trade accounts receivable	$	4,096	$	4,085
Earnouts receivable from Medtronic	1,244		17,000
Total accounts receivable	$	5,340	$	21,085

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 March 31, 2023 and December 31, 2022 (in thousands):


	Fair Value Measurements as of March 31, 2023
	(unaudited)
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets included in:
Cash and cash equivalents
Money market securities	$	20,211	$	—	$	—	$	20,211
Marketable securities at fair value
U.S. treasury securities	—		21,814		—		21,814
Commercial paper	—		21,806		—		21,806
Yankee debt securities	—		3,219		—		3,219
Total fair value	$	20,211	$	46,839	$	—	$	67,050

Liabilities included in:
Warrant liability	$	—	$	—	$	1,900	$	1,900
Contingent consideration	—		—		2,000		2,000
Total fair value	$	—	$	—	$	3,900	$	3,900


	Fair Value Measurements as of December 31, 2022
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets included in:
Cash and cash equivalents
Money market securities	$	22,700	$	—	$	—	$	22,700
Marketable securities at fair value
U.S. treasury securities	—		26,897		—		26,897
Commercial paper	—		14,764		—		14,764
Yankee debt securities	—		3,202		—		3,202
Total fair value	$	22,700	$	44,863	$	—	$	67,563

Liabilities included in:
Warrant liability	$	—	$	—	$	3,346	$	3,346
Contingent consideration	—		—		1,800		1,800
Total fair value	$	—	$	—	$	5,146	$	5,146

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 three months ended March 31, 2023 (in thousands):


	Contingent Consideration		Warrant Liability
Balance, December 31, 2022	$	1,800	$	3,346
Change in fair value	200		(1,446)
Balance, March 31, 2023 (unaudited)	$	2,000	$	1,900

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 March 31, 2023 and December 31, 2022 were as follows:


	March 31, 2023	December 31, 2022
	(unaudited)
Risk-free interest rate	5.00%	4.80%
Expected term in years	1.0 - 2.0	1.0 - 2.0
Expected volatility	23.4%	28.0%

Weighted-Average Unobservable Inputs to Measure Warranty Liability

The fair value was estimated to be $0.5026 per warrant as of March 31, 2023 and the significant inputs used in the estimation of the fair value were as follows:


			March 31, 2023
			(unaudited)
Risk-free interest rate			3.55%
Expected term in years			7.25
Expected volatility			75.0%

As of March 31, 2023 and December 31, 2022, the outstanding warrants to purchase the Company’s common stock consisted of the following:


	Exercise Price		Expiration Date	March 31, 2023	December 31, 2022
				(unaudited)
Warrants issued in 2015	$	5.25	1/30/25	3,808	3,808
Warrants issued with 2018 Convertible Notes	$	0.10	6/7/28	346,689	346,689
Warrants issued with 2018 Term Loan	$	16.67	7/31/28	26,998	26,998
Warrants issued with 2019 Credit Agreement	$	16.67	5/20/29	419,992	419,992
Warrants issued with 2022 Credit Agreement	$	1.11	6/30/30	3,779,018	3,779,018
Total Warrants				4,576,505	4,576,505

Summary of Significant Accounting Policies - Weighted-Average Unobservable Inputs to Measure Warranty Liability (Details) - Significant Unobservable Inputs (Level 3) - Vesting of RSUs and RSAs	Mar. 31, 2023 year $ / shares
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Share price (in usd per share) \| $ / shares	$ 0.5026
Risk-free interest rate
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants and rights outstanding, measurement input	0.0355
Expected term in years
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants and rights outstanding, measurement input \| year	7.25
Expected volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants and rights outstanding, measurement input	0.750

Stock-Based Compensation - Summary of the Total Stock-Based Compensation Expense for the Stock Options, PSUs and RSAs Recorded in the Condensed Consolidated Statements of Operations and Comprehensive Loss (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 1,904	$ 3,032
Cost of products sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	74	226
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	346	514
Selling, general and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation	$ 1,484	$ 2,292

Operating Leases - Summary of Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Operating leases
Operating lease cost	$ 251	$ 247
Variable lease cost	81	77
Total operating lease expense	$ 332	$ 324

Organization and Description of Business (Details) - USD ($) $ / shares in Units, $ in Thousands					1 Months Ended		3 Months Ended
	Feb. 01, 2023	Jan. 13, 2023	Jun. 30, 2022	Aug. 10, 2020	Nov. 30, 2022	Jul. 31, 2021	Mar. 31, 2023	Mar. 31, 2022	Jan. 31, 2023	Dec. 31, 2022
Subsidiary, Sale of Stock [Line Items]
Cash, cash equivalents, restricted cash and marketable securities							$ 76,700			$ 76,200
Net loss							16,315	$ 40,017
Net cash used in operating activities							(16,515)	(27,609)
Accumulated deficit							534,629			518,314
Working capital							84,700			$ 98,000
Proceeds from sale of business							17,000	$ 0
Left-Heart Access Portfolio
Subsidiary, Sale of Stock [Line Items]
Contingent consideration received from sales							$ 1,200
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Subsidiary, Sale of Stock [Line Items]
Proceeds from sale of business		$ 17,000	$ 50,000		$ 20,000
Indemnity escrow account, amount			$ 4,000		$ 1,600				$ 1,400
Indemnity escrow account, term			18 months
Milestone consideration, period	4 years
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year one
Subsidiary, Sale of Stock [Line Items]
Milestone consideration, royalty percentage	100.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year two
Subsidiary, Sale of Stock [Line Items]
Milestone consideration, royalty percentage	75.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year three
Subsidiary, Sale of Stock [Line Items]
Milestone consideration, royalty percentage	50.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year four
Subsidiary, Sale of Stock [Line Items]
Milestone consideration, royalty percentage	50.00%
IPO
Subsidiary, Sale of Stock [Line Items]
Proceeds from issuance, initial public offering				$ 166,300
Over-Allotment Option
Subsidiary, Sale of Stock [Line Items]
Issuance of common stock for cash, net of issuance costs (in shares)						825,000
Public Stock Offering
Subsidiary, Sale of Stock [Line Items]
Issuance of common stock for cash, net of issuance costs (in shares)						6,325,000
Price per share (in dollars per share)						$ 14.00
Consideration received on transaction						$ 88,600
Proceeds from issuance of stock						$ 82,700

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Statement of Comprehensive Income [Abstract]
Revenue	$ 4,170	$ 3,681
Cost of products sold	6,790	6,941
Gross profit	(2,620)	(3,260)
Operating (income) expenses:
Research and development	6,117	8,003
Selling, general and administrative	9,565	14,385
Goodwill impairment	0	12,026
Restructuring	12	949
Change in fair value of contingent consideration	200	7
Gain on sale of business	(1,207)	0
Total operating (income) expenses	14,687	35,370
Loss from operations	(17,307)	(38,630)
Other income (expense):
Change in fair value of warrant liability	(1,446)	0
Interest income	853	24
Interest expense	(1,307)	(1,411)
Total other income (expense), net	992	(1,387)
Loss before income taxes	(16,315)	(40,017)
Income tax benefit	0	0
Net loss	(16,315)	(40,017)
Other comprehensive income (loss)
Unrealized gain (loss) on marketable securities	12	(57)
Foreign currency translation adjustment	59	(166)
Comprehensive loss	$ (16,244)	$ (40,240)
Basic net loss per common share (in dollars per share)	$ (0.57)	$ (1.42)
Diluted net loss per common share (in dollars per share)	$ (0.57)	$ (1.42)
Basic weighted average shares outstanding (in shares)	28,764,444	28,118,090
Diluted weighted average shares outstanding (in shares)	28,764,444	28,118,090

Inventory (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 10,253	$ 9,179
Work in process	1,843	2,025
Finished goods	2,842	2,123
Total inventory	$ 14,938	$ 13,327

Related Party Transactions	3 Months Ended
Related Party Transactions	Mar. 31, 2023
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions Consulting Agreement The Company has a consulting agreement with the chairman of the Company’s Board of Directors. The Company recorded less than $0.1 million of expense related to the agreement for both the three months ended March 31, 2023 and 2022. Credit Agreements The Company's prior credit agreement (the "2019 Credit Agreement") was between the Company and related parties OrbiMed Royalty Opportunities II, LP and Deerfield Private Design Fund II, L.P., and provided for a loan of up to $70.0 million with a maturity date of May 20, 2024. On June 30, 2022, the loan balance of $40.0 million was repaid in full out of the proceeds of the 2022 Credit Agreement. The 2022 Credit Agreement with related parties Deerfield Private Design Fund III, L.P. and Deerfield Partners, L.P. replaced the 2019 Credit Agreement and provides for an aggregate principal amount of $35.0 million and a maturity date five years from the closing of the loan. Refer to Note 10 - Debt for additional details. The liability for the loan balance related to the 2022 Credit Agreement and the 2019 Credit Agreement recorded on the Company's consolidated balance sheets was $34.4 million and $40.4 million as of December 31, 2022 and 2021, respectively. The Company recorded interest expense related to the debt on the consolidated statement of operations and comprehensive loss of $5.1 million and $5.7 million for the years ended December 31, 2022 and 2021, respectively. Warrants In connection with the 2022 Credit Agreement, the Company entered into the 2022 Warrant Purchase Agreement with Deerfield, pursuant to which the Company issued warrants for the purchase up to an aggregate 3,779,018 shares of the Company’s common stock at an exercise price of $1.1114 per share for a period of eight years following issuance. Refer to Note 13 - Warrants for additional details. Registration Rights Agreement On June 30, 2022, in connection with the issuance of the 2022 Warrants, the Company also entered into a registration rights agreement (the “Registration Rights Agreement”) with Deerfield, pursuant to which the Company filed a shelf registration statement on Form S-3 with the SEC to register the resale of certain securities held by Deerfield and their affiliates (the “Registrable Securities”). In addition, for a period of five years following the execution of the Registration Rights Agreement, or until all Registrable Securities are registered or no longer subject to restrictions on transfer (whichever is earlier), Deerfield will hold certain “piggy-back” registration rights with respect to registration statements filed during such period. The Company will generally pay all reasonable expenses incidental to its obligations and performance under the Registration Rights Agreement, other than underwriting discounts and commissions and such other charges.

Sale of Business - Narrative (Details) - USD ($) $ in Thousands				1 Months Ended	3 Months Ended		12 Months Ended
	Feb. 01, 2023	Jan. 13, 2023	Jun. 30, 2022	Nov. 30, 2022	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Jan. 31, 2023
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of business					$ 17,000	$ 0
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of business		$ 17,000	$ 50,000	$ 20,000
Indemnity escrow account, amount			$ 4,000	$ 1,600					$ 1,400
Indemnity escrow account, term			18 months
Milestone consideration, period	4 years
Amount earned and recorded as a receivable					1,200
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, period							4 years
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Medtronic
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on sale of business, net					$ 1,207			$ 79,500
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year one
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage	100.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year one \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage							100.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year two
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage	75.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year two \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage							75.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year three
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage	50.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year three \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage							50.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year four
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage	50.00%
Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations \| Left-Heart Access Portfolio \| Year four \| Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Milestone consideration, royalty percentage							50.00%

Inventory

3 Months Ended

Mar. 31, 2023

Inventory Disclosure [Abstract]

Inventory

Inventory as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Raw materials	$	10,253	$	9,179
Work in process	1,843		2,025
Finished goods	2,842		2,123
Total inventory	$	14,938	$	13,327

Intangible Assets - Summary of Remaining Amortization Expense (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Nine months ending December 31, 2023	$ 150
Year ending December 31, 2024	200
Year ending December 31, 2025	200
Year ending December 31, 2026	200
Year ending December 31, 2027	200
Thereafter	583
Finite-lived intangible assets, net	$ 1,533	$ 1,583

Stock-Based Compensation - Summary of Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Stock Options
Outstanding at beginning of period (in shares)	2,898,821
Options granted (in shares)	592,500
Options exercised (in shares)	(3,218)
Options forfeited (in shares)	(35,224)
Outstanding at end of period (unaudited) (in shares)	3,452,879	2,898,821
Options vested and exercisable at end of period (unaudited) (in shares)	2,019,014
Weighted Average Exercise Price
Outstanding at beginning of period (in dollars per share)	$ 6.83
Options granted (in dollars per share)	1.41
Options exercised (in dollars per share)	1.34
Options forfeited (in dollars per share)	2.10
Outstanding at end of period (unaudited)(in dollars per share)	5.96	$ 6.83
Options vested and exercisable at end of period (unaudited) (in dollars per share)	$ 7.88
Stock Options Activity, Additional Disclosures
Weighted average remaining contractual life, Outstanding	7 years 2 months 12 days	6 years 10 months 24 days
Weighted average remaining contractual life, Options vested and exercisable at end of period (unaudited)	5 years 10 months 24 days
Aggregate intrinsic value, Outstanding balance at beginning of period	$ 79
Aggregate intrinsic value, Options exercised	1
Aggregate intrinsic value, Outstanding balance at end of period (unaudited)	29	$ 79
Aggregate intrinsic value, Options vested and exercisable at end of period (unaudited)	$ 0

Stockholders’ Equity	3 Months Ended
Stockholders’ Equity	Mar. 31, 2023
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 (the "Preferred Stock"). In connection with the issuance of the Preferred Stock pursuant to the Exchange Agreements, on August 23, 2021, the Company filed a Certificate of Designation of Preferences, Rights and Limitations of the Series A Common Equivalent Preferred Stock of the Company with the Secretary of State of the State of Delaware. The Preferred Stock ranks senior to the common stock with respect to rights on the distribution of assets on any voluntary or involuntary liquidation, dissolution or winding up of the affairs of the Company, having a liquidation preference equal to its par value of $0.001 per share. The Preferred Stock will participate equally and ratably on an as-converted basis with the holders of common stock in all cash dividends paid on the common stock. The Preferred Stock is non-voting. Upon election, each holder may convert each share of Preferred Stock into 1,000 shares of common stock, except to the extent that following such conversion the number of shares of common stock held by such holder, its affiliates and any other persons whose beneficial ownership of common stock would be aggregated with such holder’s for purposes of Section 13(d) of the Exchange Act including shares held by any “group” (as defined in Section 13(d) of the Securities Exchange Act of 1934, as amended (the "Exchange Act") and applicable regulations of the Securities and Exchange Commission ("SEC")) of which such holder is a member, but excluding shares beneficially owned by virtue of the ownership of securities or rights to acquire securities that have limitations on the right to convert, exercise or purchase similar to the limitation set forth in the Series A Certificate of Designation, exceeds 4.9% (or, at the election of the holders, OrbiMed Private Investments IV, LP or OrbiMed Royalty Opportunities II, LP, made by delivering at least 61 days advance written notice to the Company of its intention to increase the beneficial ownership cap applicable to such holder, 9.9%) of the total number of shares of common stock then issued and outstanding. Common Stock During the three months ended March 31, 2023 and 2022, stock options to acquire 3,218 shares and 35,478 shares, respectively, were exercised for shares of the Company's common stock with proceeds of less than $0.1 million and $0.1 million, respectively. Additionally in conjunction with the 2020 Employee Stock Purchase Plan (the "2020 ESPP"), during the three months ended March 31, 2022, 94,226 shares of common stock were issued for consideration of $0.2 million. No shares were issued related to the 2020 ESPP during the three months ended March 31, 2023. During the three months ended March 31, 2023 and 2022, the Company issued 336,206 shares and 192,138 shares, respectively, of common stock upon vesting of RSUs.

- 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://fasb.org/us-gaap/role/ref/legacyRef
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Intangible Assets - Summary of Finite and Indefinite Lived Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Intangible Assets	$ 2,000	$ 2,000
Accumulated Amortization	(467)	(417)
Finite-lived intangible assets, net	$ 1,533	$ 1,583
Licensed intangibles
Finite-Lived Intangible Assets [Line Items]
Estimated Useful Life	10 years	10 years
Weighted Average Remaining Life	7 years 8 months 12 days	7 years 10 months 24 days
Intangible Assets	$ 2,000	$ 2,000
Accumulated Amortization	(467)	(417)
Finite-lived intangible assets, net	$ 1,533	$ 1,583

Stock-Based Compensation - Schedule of Estimate of the Fair Value of Stock Option (Details)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	4.27%	1.76%
Expected dividend yield	0.00%	0.00%
Expected term	5 years 7 months 6 days	6 years
Expected volatility	75.00%	75.00%

Property and Equipment, Net

3 Months Ended

Mar. 31, 2023

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

Property and Equipment, NetThe Company’s property and equipment, net, consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Medical diagnostic equipment	$	15,042	$	14,826
Furniture and fixtures	400		432
Office equipment	1,556		1,556
Laboratory equipment and software	5,226		5,148
Leasehold improvements	608		580
Construction in process	2,008		2,166
Total property and equipment	24,840		24,708
Less: accumulated depreciation	(16,695)		(15,487)
Property and equipment, net	$	8,145	$	9,221

Property and equipment includes certain medical diagnostic equipment and AcQMap Systems located at customer premises. The Company retains ownership of the equipment and has the right to remove the equipment if it is not being used according to expectations. The Company records the cost of equipment to cost of sales on the condensed consolidated statements of operations and comprehensive loss when it is subsequently sold or the Company enters into a sales-type lease agreement. See Note 6 - Lessor Sales-Type Leases for additional details.

Depreciation expense was $1.3 million and $1.6 million for the three months ended March 31, 2023 and 2022, respectively

Warrants - Schedule of Outstanding Warrants to Purchase the Company's Common Stock (Details) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Class of Warrant or Right [Line Items]
Warrants outstanding (in shares)	4,576,505	4,576,505
Common Stock \| Warrants issued in 2015
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 5.25
Warrants outstanding (in shares)	3,808	3,808
Common Stock \| Warrants issued with 2018 Convertible Notes
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 0.10
Warrants outstanding (in shares)	346,689	346,689
Common Stock \| Warrants issued with 2018 Term Loan
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 16.67
Warrants outstanding (in shares)	26,998	26,998
Common Stock \| 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
Common Stock \| Warrants issued with 2022 Credit Agreement
Class of Warrant or Right [Line Items]
Exercise price (in dollars per share)	$ 1.11
Warrants outstanding (in shares)	3,779,018	3,779,018

Operating Leases - Summary of Future Minimum Payments Under the Non-Cancelable Operating Leases (Details) $ in Thousands	Mar. 31, 2023 USD ($)
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
Nine months ending December 31, 2023	$ 330
Year ending December 31, 2024	1,159
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Year ending December 31, 2027	1,221
Total	5,046
Less: present value discount	(824)
Operating lease liabilities	$ 4,222

Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Summary of Intangible Assets Activities

The following table presents intangible assets activity for the three months ended March 31, 2023 (in thousands):


	Intangible Assets
Balance, December 31, 2022	$	1,583
Amortization expense	(50)
Balance, March 31, 2023 (unaudited)	$	1,533

Summary of Finite Lived Intangible Assets

The tables below present the details of intangible assets as of March 31, 2023 and December 31, 2022 (dollars in thousands):


March 31, 2023	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets		Accumulated Amortization		Balance
							(unaudited)


Licensed intangibles	10.0	7.7	$	2,000	$	(467)	$	1,533
Total intangible assets			$	2,000	$	(467)	$	1,533


December 31, 2022	Estimated Useful Life (in years)	Weighted Average Remaining Life (in years)	Intangible Assets			Accumulated Amortization		Balance
Licensed intangibles	10.0	7.9	2,000			(417)		1,583
Total intangible assets			$	2,000	Rx	$	(417)	$	1,583

Summary of Remaining Amortization Expense

The following table presents the future amortization expense associated with amortizable intangible assets as of March 31, 2023 (in thousands):


	Total Amortization
Nine months ending December 31, 2023	$	150
Year ending December 31, 2024	200
Year ending December 31, 2025	200
Year ending December 31, 2026	200
Year ending December 31, 2027	200
Thereafter	583
Total future amortization	$	1,533

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Basis of Presentation

The condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”) for interim financial information and the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and notes required by U.S. GAAP for complete financial statements. In the opinion of management, the condensed consolidated financial statements reflect all adjustments, which include only normal recurring adjustments necessary for the fair statement of the balances and results for the periods presented. Certain information and note disclosures normally included in the Company’s annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. These condensed consolidated financial statement results are not necessarily indicative of results to be expected for the full fiscal year or any future period.

Principles of Consolidation

The condensed consolidated financial statements include the accounts of Acutus Medical, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.

Use of Estimates and Assumptions

The preparation of the condensed consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, expenses and disclosures of contingent assets and liabilities. These estimates and assumptions are based on current facts, historical experience and various other factors believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities and the recording of revenue and expenses that are not readily apparent from other sources. Actual results could differ from those estimates.

Segments

Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision maker in making decisions regarding resource allocation and assessing performance. The Company views its operations and manages its business as one operating segment and reportable segment.

Cash and Cash Equivalents and Restricted Cash

The Company considers all highly liquid investments with maturities of three months or less when purchased to be cash equivalents. All of the Company’s cash equivalents have liquid markets and high credit ratings. The Company maintains its cash in bank deposits and other accounts, the balances of which, at times and as of March 31, 2023 and December 31, 2022, exceeded federally insured limits.

Restricted cash consists of (i) deposited cash collateral for the Company’s corporate credit card program and (ii) cash received for the sale of business to Medtronic held in an indemnity escrow account until certain terms of sale are met.

The following table reconciles cash, cash equivalents and restricted cash in the condensed consolidated balance sheets to the total balances as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Cash and cash equivalents	$	22,738	$	25,584
Restricted cash	7,139		5,764
Total cash, cash equivalents and restricted cash	$	29,877	$	31,348

Marketable Securities

The Company’s marketable securities portfolio consists of investments in money market funds, commercial paper, U.S. treasury securities and Yankee debt securities.

The Company considers its debt securities to be available-for-sale securities. Available-for-sale securities are classified as cash equivalents or short-term or long-term marketable securities based on the maturity date at time of purchase and their availability

to meet current operating requirements. Marketable securities that mature in three months or less from the date of purchase are classified as cash equivalents. Marketable securities, excluding cash equivalents, that mature in one year or less are classified as short-term available-for-sale securities and are reported as a component of current assets.

Securities that are classified as available-for-sale are measured at fair value with temporary unrealized gains and losses reported in other comprehensive loss, and as a component of stockholders’ equity until their disposition or maturity. 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 condensed 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 condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023 and 2022.

Concentrations of Credit Risk and Off-Balance Sheet Risk

Financial instruments that potentially subject the Company to credit risk consist principally of cash, cash equivalents, restricted cash, accounts receivable and marketable securities. Cash and restricted cash are maintained in accounts with financial institutions which, at times, may exceed the federal depository insurance coverage of $0.25 million. The Company has not experienced losses on these accounts, and management believes, based upon the quality of the financial institutions, that the credit risk with regard to these deposits is not significant.

Revenue from Contracts with Customers

The Company accounts for revenue earned from contracts with customers under Accounting Standards Codification ("ASC") 606, Revenue from Contracts with Customers (“ASC 606”), and ASC 842, Leases ("ASC 842"). The core principle of ASC 606 is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The following five steps are applied to achieve that core principle:

•Step 1: Identify the contract with the customer.

•Step 2: Identify the performance obligations in the contract.

•Step 3: Determine the transaction price.

•Step 4: Allocate the transaction price to the performance obligations in the contract.

•Step 5: Recognize revenue when, or as, the company satisfies a performance obligation.

ASC 842 provides guidance on determining whether an agreement contains a lease. ASC 842 defines a lease as a contract, or part of a contract, that conveys the right to control the use of identified property, plant or equipment for a period of time in exchange for consideration.

For new customers, the Company places its medical diagnostic equipment, the AcQMap System, at customer sites under evaluation agreements and generates revenue from the sale of disposable products used with the AcQMap System. Disposable products primarily include AcQMap catheters and AcQGuide steerable sheaths. Outside of the United States, 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.

Additionally, the Company sells the AcQMap System to customers along with software updates on a when-and-if-available basis, as well as the Qubic Force Device and a transseptal crossing line of products which can be used in a variety of heart procedures and does not need to be accompanied with an AcQMap System or Qubic Force Device. Included in the transseptal

crossing line of products are primarily the AcQRef Introducer Sheath, the AcQGuide Sheaths and the AcQCross Transseptal Dilator/Needle.

The Company also enters into deferred equipment agreements that are generally structured such that the Company agrees to provide an AcQMap System at no up-front charge, with title of the device transferring to the customer at the end of the contract term, in exchange for the customer’s commitment to purchase disposables at a specified price over the term of the agreement, which generally ranges from two to four years. The Company has determined that such 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 is 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 AcQMap System after an evaluation. These lease agreements impose no requirement on the customer to purchase the equipment, and the equipment is not transferred to the customer at the end of the lease term. The short-term nature of the lease agreements does not result in lease payments accumulating to an amount that equals the value of the equipment nor is the lease term reflective of the economic life of the equipment.

The Company’s contracts primarily include fixed consideration. Generally, there are no discounts, rebates, returns or other forms of variable consideration. Customers are generally required to pay within 30 to 60 days.

The delivery of disposable products are performance obligations satisfied at a point in time. The disposable products are shipped Free on Board (“FOB”) shipping point or FOB destination. For disposable products that are shipped FOB shipping point, the customer has the significant risks and rewards of ownership and legal title to the assets when the disposable products leave the Company’s shipping facilities, and 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 include, but are not limited to, sales transactions where the specific performance obligations are sold separately, Company list prices and specific offers to customers.

Except for the deferred equipment agreements noted above, the Company’s contracts with customers generally have an expected duration of one year or less, and therefore the Company has elected the practical expedient in ASC 606 to not disclose information about its remaining performance obligations. Any incremental costs to obtain contracts are recorded as selling, general and administrative ("SG&A") expense as incurred due to the short duration of the Company’s contracts. The Company’s contract balances consisted solely of accounts receivable as of March 31, 2023 and December 31, 2022.

In May 2020, the Company entered into bi-lateral distribution agreements (the “Bi-Lateral Distribution Agreements”) with Biotronik. Pursuant to the Bi-Lateral Distribution Agreements, the Company obtained a non-exclusive license to distribute a range of Biotronik’s products and accessories in the United States, Canada, China, Hong Kong and multiple Western European countries under the Company’s private label. Moreover, if an investigational device exemption (“IDE”) clinical trial is required for these products to obtain regulatory approval in the United States, or a clinical trial is required for these products to obtain regulatory approval in China, the Company will obtain an exclusive distribution right in such territories for a term of up to five years commencing on the date of regulatory approval if the Company covers the cost of the IDE or other clinical trial and the Company conducts such study within a specified period. Biotronik also agreed to distribute the Company’s products and accessories in Germany, Japan, Mexico, Switzerland and multiple countries in Asia-Pacific, Eastern Europe, the Middle East and South America. The Company also granted Biotronik a co-exclusive right to distribute these products in Hong Kong. Each party will pay to the other party a specified transfer price on the sale of the other party’s products and, accordingly, will earn a distribution margin on the sale of the other party’s products.

In 2022, the Company sold the left-heart access transseptal crossing business to Medtronic. In connection with the sale, the Company entered into a distribution agreement (the "Distribution Agreement") with Medtronic, pursuant to which the Company acts as the original equipment manufacturer ("OEM") supplier of these products. The Company will produce and sell the products to Medtronic for a period of up to four years. Revenue is recognized when the title to the products are transferred to Medtronic, which occurs when the products are shipped from our facility (or FOB shipping point).

The following table sets forth the Company’s revenue for disposables, systems and service/other for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Disposables	$	3,426	$	3,211
Systems	—		—
Service/Other	744		470
Total revenue	$	4,170	$	3,681

The following table provides revenue by geographic location for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
United States	$	2,248	$	2,023
Outside the United States	1,922		1,658
Total revenue	$	4,170	$	3,681

Inventory

Inventory is stated at the lower of cost (first-in, first-out basis) or net realizable value. The Company recorded write-downs for excess and obsolete inventory of $0.3 million and $1.0 million for the three months ended March 31, 2023 and 2022, respectively, based on management’s review of inventories on hand, comparisons to estimated future usage and sales, observed shelf-life and assumptions about the likelihood of obsolescence.

Accounts Receivable

Trade accounts receivable are recorded net of allowances for uncollectible accounts. The Company evaluates the collectability of its accounts receivable based on various factors including historical experience, the length of time the receivables are past due and the financial health of the customer. The Company reserves specific receivables if collectability is no longer reasonably assured. Based upon the assessment of these factors, the Company did not record an allowance for uncollectible accounts as of March 31, 2023 or December 31, 2022.

Pursuant to the Asset Purchase Agreement with Medtronic, the Company was eligible to receive the Transfer Earnout, a contingent cash consideration of $17.0 million upon the Company’s initial submission for CE Mark certification. The Company met this condition as of December 31, 2022 and recorded a receivable on the consolidated balance sheets for the year then ended. Medtronic provided full payment in January 2023. See Note 3 - Sale of Business.

In addition, beginning in February 2023, following Medtronic's first commercial sale of the left-heart access products after the Company's achievement of the OEM Earnout (as defined in Note 3 - Sale of Business, below), the Company became eligible to earn amounts equal to 100%, 75%, 50% and 50%, respectively, of quarterly Net Sales (as defined in the Asset Purchase Agreement) from sales of the left-heart access products achieved by Medtronic each year over four years. During the three months ended March 31, 2023, the Company earned $1.2 million in contingent consideration based on Medtronic's left-heart access products sales and recorded a receivable on the condensed consolidated balance sheets for the period then ended.

Accounts receivable recorded on the condensed consolidated balance sheets as of March 31, 2023 and December 31, 2022 consists of the following (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Trade accounts receivable	$	4,096	$	4,085
Earnouts receivable from Medtronic	1,244		17,000
Total accounts receivable	$	5,340	$	21,085

Employee Retention Credit Receivable

The Employee Retention Credit is a refundable U.S. tax credit separate from tax based on income for businesses that continued to pay employees while shut down due to the COVID-19 pandemic or had significant declines in gross receipts from March 13, 2020 to December 31, 2021. The Company is an eligible employer qualifying under the program and applied for the tax credit in 2022. As of March 31, 2023, $4.2 million has been refunded to the Company, of which $2.1 million was received during the three months ended March 31, 2023. The Company expects receipt of the remaining $2.6 million receivable in 2023.

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

The Company’s intangible assets consists of a license agreement with Biotronik. The Company determines the appropriate useful life of its finite-lived intangible assets by performing an analysis of expected cash flows of the acquired assets. Finite-lived intangible assets are amortized over their estimated useful lives using the straight-line method, which approximates the pattern in which the economic benefits are consumed. Acquired in-process technology is classified as a finite-lived intangible and amortized accordingly. Indefinite-lived intangible assets are tested for impairment at least annually and are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Indefinite-lived intangible assets are impaired if their estimated fair values are less than their carrying value.

Goodwill

Goodwill 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 condensed 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 first assesses qualitative factors to determine whether the existence of events or circumstances led to a determination that it was more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events or circumstances, it is determined that it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company is required to perform the quantitative goodwill impairment test. The Company has one reporting unit. During the three months ended March 31, 2022, the Company fully impaired its goodwill balance of $12.0 million.

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 three months ended March 31, 2023 and 2022, 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 Medical N.V. and Acutus Medical UK Limited are measured using their functional currency, the Euro and British Pound Sterling, respectively, which is the currency of the primary foreign economic environment in which the subsidiaries operate. Upon consolidating these entities with the Company, their assets and liabilities are translated to U.S. dollars at currency exchange rates as of the balance sheet date and their 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 the entities’ financial statements are reported in accumulated other comprehensive loss in the condensed consolidated balance sheets and foreign currency translation adjustment in the condensed consolidated statements of operations and comprehensive loss.

Lease Property

The Company leases office space in Carlsbad, California as its corporate headquarters and for manufacturing operations. Additionally, it leases office space in Zaventem, Belgium for international operations. The Company accounts for its lease property under ASC 842. Under this guidance, arrangements meeting the definition of a lease are classified as operating or financing leases, and are recorded on the consolidated balance sheet as both a right-of-use asset and a lease liability, calculated by discounting fixed lease payments over the lease term at the rate implicit in the lease or the Company’s incremental borrowing rate, which is the rate for collateralized borrowings based on the current economic environment, credit history, credit rating, value of leases, currency in which the lease obligation is satisfied, rate sensitivity, lease term and materiality. Lease liabilities are increased by interest and reduced by payments each period, and the right-of-use asset is amortized over the lease term. For operating leases, interest on the lease liability and the amortization of the right-of-use asset results in straight-line rent expense over the lease term. Variable lease expenses are recorded when incurred.

In calculating the right-of-use asset and lease liability, the Company elected to combine lease and non-lease components. The Company adopted the policy election to exclude short-term leases having initial terms of twelve months from the initial recognition provisions of ASC 842. See Note 12 - Operating leases for additional details.

Cost of Products Sold

Cost of products sold includes raw materials, direct labor, manufacturing overhead, shipping and receiving costs and other less significant indirect costs related to the production of the Company’s products.

Research and Development

The Company is actively engaged in new product research and development efforts. Research and development expenses consist primarily of salaries and employee-related costs (including stock-based compensation) for personnel directly engaged in research and development activities, clinical trial expenses, equipment costs, material costs, allocated rent and facilities costs and depreciation.

Research and development expenses relating to possible future products are expensed as incurred. The Company also accrues and expenses costs for activities associated with clinical trials performed by third parties as incurred. All other costs relative to setting up clinical trial sites are expensed as incurred. Clinical trial site costs related to patient enrollment are accrued as patients are entered into the trials.

Selling, General and Administrative

SG&A 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

Financial Instruments

Fair value measurements are based on the premise that fair value is an exit price representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the following three-tier fair value hierarchy is used in determining the inputs for measuring fair value:

Level 1—Quoted prices in active markets for identical assets or liabilities.

Level 2—Observable inputs other than Level 1 prices for similar assets or liabilities that are directly or indirectly observable in the marketplace.

Level 3—Unobservable inputs which are supported by little or no market activity and consist of financial instruments valued using pricing models, discounted cash flow methodologies or similar techniques, as well as instruments for which the determination of fair value requires significant judgment or estimation.

Financial instruments measured at fair value are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. Management’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. The use of different assumptions and/or estimation methodologies may have a material effect on estimated fair values. Accordingly, the fair value estimates disclosed or initial amounts recorded may not be indicative of the amount that the Company or holders of the instruments could realize in a current market exchange. There were no transfers made among the three levels in the fair value hierarchy for the three months ended March 31, 2023 and 2022.

As of March 31, 2023 and December 31, 2022, the Company’s cash (excluding cash equivalents which are recorded at fair value on a recurring basis), restricted cash, accounts receivable, accounts payable and accrued expenses were carried at cost, which approximates the fair values due to the short-term nature of each instrument. The carrying amount of the Company’s long-term debt approximates fair value due to its variable market interest rate and management’s opinion that current rates and terms that would be available to the Company with the same maturity and security structure would be essentially equivalent to that of the Company’s long-term debt.


	Fair Value Measurements as of March 31, 2023
	(unaudited)
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets included in:
Cash and cash equivalents
Money market securities	$	20,211	$	—	$	—	$	20,211
Marketable securities at fair value
U.S. treasury securities	—		21,814		—		21,814
Commercial paper	—		21,806		—		21,806
Yankee debt securities	—		3,219		—		3,219
Total fair value	$	20,211	$	46,839	$	—	$	67,050

Liabilities included in:
Warrant liability	$	—	$	—	$	1,900	$	1,900
Contingent consideration	—		—		2,000		2,000
Total fair value	$	—	$	—	$	3,900	$	3,900


	Fair Value Measurements as of December 31, 2022
	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets included in:
Cash and cash equivalents
Money market securities	$	22,700	$	—	$	—	$	22,700
Marketable securities at fair value
U.S. treasury securities	—		26,897		—		26,897
Commercial paper	—		14,764		—		14,764
Yankee debt securities	—		3,202		—		3,202
Total fair value	$	22,700	$	44,863	$	—	$	67,563

Liabilities included in:
Warrant liability	$	—	$	—	$	3,346	$	3,346
Contingent consideration	—		—		1,800		1,800
Total fair value	$	—	$	—	$	5,146	$	5,146

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

The fair value for the available-for-sale marketable securities is determined based on valuation models using inputs that are observable either directly or indirectly (Level 2 inputs) such as quoted prices for similar assets, yield curve, volatility factors, credit spreads, default rates, loss severity, current market and contractual prices for the underlying instruments, broker and dealer quotes, as well as other relevant economic measures.

Financial Obligations

The following table presents changes in Level 3 liabilities measured at fair value for the three months ended March 31, 2023 (in thousands):


	Contingent Consideration		Warrant Liability
Balance, December 31, 2022	$	1,800	$	3,346
Change in fair value	200		(1,446)
Balance, March 31, 2023 (unaudited)	$	2,000	$	1,900

Unrealized gains and losses associated with liabilities within the Level 3 category include changes in fair value that were attributable to both observable (e.g., changes in market interest rates) and unobservable (e.g., changes in unobservable long-dated volatilities) inputs.

Contingent Consideration

The fair value of the contingent consideration from the acquisition of Rhythm Xience, Inc. ("Rhythm Xience") in June 2019 represents the estimated fair value of future payments due to the sellers of Rhythm Xience based on the achievement of certain milestones and revenue-based targets in certain years. The initial fair value of the revenue-based contingent consideration was calculated through the use of a Monte Carlo simulation using revenue projections for the respective earn-out period, corresponding targets and approximate timing of payments as outlined in the purchase agreement. The analyses used the following assumptions: (i) expected term; (ii) risk-adjusted net sales; (iii) risk-free interest rate; and (iv) expected volatility of net sales (see table below). Estimated payments, as determined through the respective model, were further discounted by a credit spread assumption to account for credit risk. The fair value of the milestones-based contingent consideration was determined by probability weighting and discounting to the respective valuation date at the Company’s cost of debt. The Company’s cost of debt was determined by performing a synthetic credit rating for the Company and selecting yields based on

companies with a similar credit rating. The contingent consideration is revalued to fair value each period on the condensed consolidated balance sheets, and any increase or decrease is recorded on the condensed consolidated statements of operations and comprehensive loss. The fair value of the contingent consideration may be impacted by certain unobservable inputs, most significantly with regard to discount rates, expected volatility and historical and projected performance. Significant changes to these inputs in isolation could result in a significantly different fair value measurement.


	March 31, 2023	December 31, 2022
	(unaudited)
Risk-free interest rate	5.00%	4.80%
Expected term in years	1.0 - 2.0	1.0 - 2.0
Expected volatility	23.4%	28.0%

Warrants

As of March 31, 2023, the fair value of the common stock warrants was estimated using the Black-Scholes option pricing model. The fair value was estimated to be $0.5026 per warrant as of March 31, 2023 and the significant inputs used in the estimation of the fair value were as follows:


			March 31, 2023
			(unaudited)
Risk-free interest rate			3.55%
Expected term in years			7.25
Expected volatility			75.0%

Stock-Based Compensation

The Company accounts for all stock-based payments to employees and non-employees, including grants of stock options, restricted stock units ("RSUs"), and restricted stock awards ("RSAs"), to be recognized in the consolidated financial statements based on their respective grant date fair values. The Company estimates the fair value of stock option grants using the Black-Scholes option pricing model. The RSUs and RSAs, are valued based on the fair value of the Company’s common stock on the date of grant. The Company expenses stock-based compensation related to stock options, RSUs and RSAs over the requisite service period. All stock-based compensation costs are recorded in cost of products sold, research and development expense or SG&A expense in the condensed consolidated statements of operations and comprehensive loss based upon the respective employee’s or non-employee’s roles within the Company. Forfeitures are recorded as they occur. See Note 15—Stock-Based Compensation for additional details.

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 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 accounts for certain common stock warrants outstanding as a liability at fair value, determined using the Black-Scholes option pricing model, on the consolidated balance sheets in accordance with ASC 815, Derivatives and Hedging (“ASC 815”). The liability is subject to re-measurement at each reporting period and any change in fair value is recognized in the condensed consolidated statements of operations and comprehensive loss. See Note 13—Warrants for additional details.

Business Combinations

The Company accounts for business acquisitions using the acquisition method of accounting based on ASC 805, Business Combinations (“ASC 805”), which requires recognition and measurement of all identifiable assets acquired and liabilities assumed at their fair value as of the date control is obtained. The Company determines the fair value of assets acquired and liabilities assumed based upon its best estimates of the acquisition-date fair value of assets acquired and liabilities assumed in the acquisition. Goodwill is calculated as the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired.

Recently Adopted Accounting Pronouncements

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326) ("ASU 2016-13"). ASU 2016-13 sets forth a “current expected credit loss” model which requires the Company to measure all expected credit losses for financial instruments held at the reporting date based on historical experience, current conditions and reasonable supportable forecasts. This replaces the existing incurred loss model and is applicable to the measurement of credit losses on financial assets measured at amortized cost, available-for-sale debt securities and applies to certain off-balance sheet credit exposures. ASU 2016-13 is effective for smaller reporting companies in 2023. The Company adopted the guidance in the first quarter of 2023 with no material impact on the condensed consolidated financial statements.

Property and Equipment, Net (Tables)

3 Months Ended

Mar. 31, 2023

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment, Net

The Company’s property and equipment, net, consisted of the following as of March 31, 2023 and December 31, 2022 (in thousands):


	March 31, 2023		December 31, 2022
	(unaudited)
Medical diagnostic equipment	$	15,042	$	14,826
Furniture and fixtures	400		432
Office equipment	1,556		1,556
Laboratory equipment and software	5,226		5,148
Leasehold improvements	608		580
Construction in process	2,008		2,166
Total property and equipment	24,840		24,708
Less: accumulated depreciation	(16,695)		(15,487)
Property and equipment, net	$	8,145	$	9,221

Debt - Summary of Outstanding Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022	Jun. 30, 2022
Debt Instrument [Line Items]
Long-term debt, gross	$ 36,750	$ 36,776
Less: Unamortized debt discount and fees	(2,224)	(2,342)
Total outstanding debt, long-term	34,526	34,434
2022 Amended Credit Agreement
Debt Instrument [Line Items]
Long-term debt, gross	36,750	$ 36,776
2022 Amended Credit Agreement \| Senior Term Loan
Debt Instrument [Line Items]
Fee amount	$ 1,800		$ 1,800

Stock-Based Compensation

3 Months Ended

Mar. 31, 2023

Share-Based Payment Arrangement [Abstract]

Stock-Based Compensation

2022 Inducement Equity Incentive Plan

The 2022 Inducement Equity Incentive Plan (the “2022 Plan”), which permits the granting of nonstatutory stock options, RSUs, RSAs, stock appreciation rights, performance share units ("PSUs"), performance shares and other equity-based awards to employees, directors and consultants, became effective on March 30, 2022. As of March 31, 2023, 6,000,000 shares of common stock were authorized for issuance under the 2022 Plan, of which 5,887,500 remain available for issuance under the 2022 Plan.

2020 Equity Incentive Plan

The 2020 Equity Incentive Plan (the “2020 Plan”), which permits the granting of nonstatutory 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 March 31, 2023, 5,573,491 shares of common stock were authorized for issuance under the 2020 Plan, including 1,142,186 additional shares that were authorized on January 1, 2023. As of March 31, 2023, 1,332,061 shares remain available for issuance under the 2020 Plan.

2011 Equity Incentive Plan

The Company’s 2011 Equity Incentive Plan (the “2011 Plan”) permits the granting of incentive stock options, non-statutory stock options, RSAs, RSUs and other stock-based awards to employees, directors, officers and consultants. As of March 31, 2023, 1,318,865 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 from future awards under the 2020 Plan.

Stock Options

Stock options granted 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 set of publicly traded 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 options for the three months ended March 31, 2023 and 2022:


	Three Months Ended March 31,
	2023	2022
	(unaudited)
Risk-free interest rate	4.27%	1.76%
Expected dividend yield	—	—
Expected term in years	5.6	6.0
Expected volatility	75%	75%

The Company's stock option activity for the three months ended March 31, 2023 was as follows:


	Stock Options	Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2022	2,898,821	$	6.83	6.9	$	79
Options granted	592,500	1.41
Options exercised	(3,218)	1.34			$	1
Options forfeited	(35,224)	2.10
Outstanding as of March 31, 2023 (unaudited)	3,452,879	$	5.96	7.2	$	29
Options vested and exercisable as of March 31, 2023 (unaudited)	2,019,014	$	7.88	5.9	$	—

For options in the money, 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 common stock on the last day of the fiscal period, which was $0.75 and $1.15 as of March 31, 2023 and December 31, 2022, 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 awards granted during the three months ended March 31, 2023 was $0.94. As of March 31, 2023, the total unrecognized compensation related to unvested stock option awards granted was $5.8 million, which the Company expects to recognize over a weighted-average period of approximately 1.5 years.

Restricted Stock Units (RSUs)

The Company’s RSU activity for the three months ended March 31, 2023 was as follows:


	Number of Shares	Weighted Average Grant Price
Unvested as of December 31, 2022	1,659,898	$	4.17
Granted	1,525,000	1.41
Forfeited	(77,720)	5.53
Vested	(453,549)	2.11
Unvested as of March 31, 2023 (unaudited)	2,653,629	$	2.90

As of March 31, 2023, there was $6.1 million of unrecognized compensation related to unvested RSUs, which the Company expects to recognize over a weighted-average period of approximately 1.8 years.

Employee Stock Purchase Plan

The 2020 ESPP permits individual employees to purchase shares of the Company’s common stock from amounts accumulated under payroll deductions. The ESPP became effective on August 5, 2020 wherein 645,105 shares of common stock were authorized. Additional shares of common stock are allocated to the 2020 ESPP by the determination of the Compensation

Committee of the Company’s Board of Directors, in its sole discretion, and by evergreen provisions in the plan authorization. Automatically authorized in 2023 were 252,042 shares under the plan's evergreen provision. As of March 31, 2023, 714,179 shares are available for purchase under the Company's 2020 ESPP.

The 2020 ESPP is implemented in consecutive offering periods with a new offering period commencing on the first trading day on or after 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 used in determining compensation expense is estimated using the Black-Scholes option pricing model.

Total Stock-Based Compensation


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Cost of products sold	$	74	$	226
Research and development	346		514
Selling, general and administrative	1,484		2,292
Total stock-based compensation	$	1,904	$	3,032

Sale of Business

3 Months Ended

Mar. 31, 2023

Discontinued Operations and Disposal Groups [Abstract]

Sale of Business

On June 30, 2022, the Company completed the First Closing in accordance with the Asset Purchase Agreement with Medtronic, pursuant to which the Company agreed to sell to Medtronic certain transseptal access and sheath assets which make up the Company's left-heart access portfolio (and which comprised the Rhythm Xience product line acquired as part of the Rhythm Xience acquisition). The assets transferred to Medtronic upon the First Closing (the “Assets”) include patents, trademarks, patent and trademark applications, know-how, copyrights, prototypes and other intellectual property owned or licensed by the Company, business records and documents (including regulatory and clinical materials) and manufacturing equipment related to the AcQCross® line of sheath-compatible septal crossing devices, AcQGuide® MINI integrated crossing device and sheath, AcQGuide® FLEX Steerable Introducer with integrated transseptal dilator and needle, and AcQGuide® VUE steerable sheaths (the “Products”).

Pursuant to the Asset Purchase Agreement, Medtronic paid $50.0 million at the First Closing, of which $4.0 million was paid into an indemnity escrow account for a period of 18 months following the First Closing to secure indemnification obligations of the Company under the Asset Purchase Agreement, which the Company has recorded as restricted cash on its condensed consolidated balance sheets.

The Company is also eligible to receive the following contingent cash consideration pursuant to the Asset Purchase Agreement:

(i) $20.0 million upon the Company’s completion, to the reasonable satisfaction of Medtronic, of certain conditions set forth in the Asset Purchase Agreement relating to the Company becoming a qualified supplier of Medtronic for the Products, including demonstration of ISO 14971:2019 compliance, completion of certain test method validations and compliance with certain other reporting requirements (the “OEM Earnout”);

(ii) $17.0 million upon the earlier of (A) the Second Closing (as defined below) or (B) the Company’s initial submission for CE Mark certification of the Products under the European Union Medical Devices Regulation, to the reasonable satisfaction of a third-party regulatory consultant, subject to certain other conditions as set forth in the Asset Purchase Agreement (the “Transfer Earnout”); and

(iii) amounts equal to 100%, 75%, 50% and 50%, respectively, of quarterly Net Sales (as defined in the Asset Purchase Agreement) from sales of the Products achieved by Medtronic over each year of a four-year period beginning on the first full quarter after Medtronic’s first commercial sale of a Product and achievement of the OEM Earnout.

The $20.0 million OEM Earnout was achieved in October 2022 and payment was received in November 2022, of which $1.6 million is held in escrow and recorded as restricted cash on the condensed consolidated balance sheets. The $17.0 million Transfer Earnout was achieved in December 2022 and payment was received in January 2023, of which $1.4 million is held in escrow and recorded as restricted cash on the condensed consolidated balance sheets. During the three months ended March 31, 2023, $1.2 million was earned under item (iii) and recorded as a receivable on the condensed consolidated balance sheet as of March 31, 2023.

With the achievement of the OEM Earnout Conditions (as defined in the Asset Purchase Agreement) and upon notice from Medtronic, Medtronic became the Company's exclusive distributor of the Products under the Distribution Agreement.

The Company recorded a net gain of $79.5 million during the year ended December 31, 2022 related to the sale of business to Medtronic, calculated as the difference between the non-contingent consideration received, less direct transaction costs and the net carrying amount of the assets sold.


	Three Months Ended March 31, 2023
	(unaudited)
Percentage of Product Net Sales Earnout accrued as of March 31, 2023	$	1,244
Transaction costs	(37)
Gain on sale of business, net	$	1,207

The net gain on sale will be adjusted in future periods by the contingent consideration, based on the achievement of the predetermined milestones mentioned above. The sale was accounted for as a derecognition of a group of assets that is a business pursuant to ASC 810 - Consolidation, with the resulting gain classified as operating income within loss from operations on the condensed consolidated statements of operations and comprehensive loss. The sale does not represent a strategic shift having a major effect on the Company's operations and financial results and, consequently, does not qualify as a discontinued operation.

Marketable Securities - Narrative (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Fair Value	$ 46,839	$ 44,863
Marketable securities, short-term, maturity	1 year	1 year

Summary of Significant Accounting Policies - Summary of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Contingent Consideration
Change in fair value	$ 200	$ 7
Significant Unobservable Inputs (Level 3) \| Contingent consideration
Contingent Consideration
Balance at beginning of period	1,800
Change in fair value	200
Balance at end of period (unaudited)	2,000
Significant Unobservable Inputs (Level 3) \| Warrant liability
Contingent Consideration
Balance at beginning of period	3,346
Change in fair value	(1,446)
Balance at end of period (unaudited)	$ 1,900

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesThe Company and certain of its current and former officers have been named as defendants in two putative securities class action lawsuits filed in the United States District Court for the Southern District of California on February 14, 2022 and March 23, 2022. On July 19, 2022, the court consolidated the two actions, appointed a lead plaintiff and appointed lead counsel for the proposed class. On September 16, 2022, the lead plaintiff filed a consolidated amended complaint. The defendant thereafter filed a motion to dismiss. Due to the complex nature of the legal and factual issues involved in these class action matters, the outcome is not presently determinable and any loss is neither probable nor reasonably estimable.

Operating Leases (Tables)

3 Months Ended

Mar. 31, 2023

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 three months ended March 31, 2023 and 2022 (dollars in thousands):


	Three Months Ended March 31,
	2023			2022
	(unaudited)
Operating cash flows from operating leases	$	281		$	98

Weighted average remaining lease term – operating leases (in years)	4.7			3.4
Weighted average discount rate – operating leases	7.0		%	7.0		%

The following table provides the components of the Company’s operating lease expense for the three months ended March 31, 2023 and 2022 (in thousands):


	Three Months Ended March 31,
	2023		2022
	(unaudited)
Operating leases
Operating lease cost	$	251	$	247
Variable lease cost	81		77
Total operating lease expense	$	332	$	324

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

As of March 31, 2023, future minimum payments under the non-cancelable operating leases under ASC 842 were as follows (in thousands):


Nine months ending December 31, 2023	$	330
Year ending December 31, 2024	1,159
Year ending December 31, 2025	1,151
Year ending December 31, 2026	1,185
Year ending December 31, 2027	1,221
Total	5,046
Less: present value discount	(824)
Operating lease liabilities	$	4,222

Operating Leases - Summary of Quantitative Information About Operating Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Leases [Abstract]
Operating cash flows from operating leases	$ 281	$ 98
Weighted average remaining lease term – operating leases	4 years 8 months 12 days	3 years 4 months 24 days
Weighted average discount rate – operating leases	7.00%	7.00%

Subsequent Events	3 Months Ended
Subsequent Events	Mar. 31, 2023
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On May 1, 2023, the Company received a notice from The Nasdaq Stock Market (“Nasdaq”) that the Company is not in compliance with Nasdaq’s Listing Rule 5450(a)(1), as the minimum bid price of the Company’s common stock has been below $1.00 per share for 30 consecutive business days. The notification of noncompliance has no immediate effect on the listing or trading of the Company’s common stock on The Nasdaq Global Market. The Company has 180 calendar days, or until October 30, 2023, to regain compliance with the minimum bid price requirement. To regain compliance, the minimum bid price of the Company’s common stock must meet or exceed $1.00 per share for a minimum of ten consecutive business days during this 180-calendar day grace period. In the event the Company does not regain compliance with the minimum bid price requirement by October 30, 2023, the Company may be eligible for an additional 180-calendar day compliance period if it elects to transfer to The Nasdaq Capital Market to take advantage of the additional compliance period offered on that market. To qualify, the Company would be required to meet the continued listing requirement for market value of publicly held shares and all other initial listing standards for The Nasdaq Capital Market, with the exception of the bid price requirement, and would need to provide written notice of its intention to cure the bid price deficiency during the second compliance period. The Company’s failure to regain compliance during this period could result in delisting. The Company intends to actively monitor the bid price of its common stock and will consider available options to regain compliance with the listing requirements. There can be no assurance that the Company will be able to regain compliance with Nasdaq’s Listing Rule 5450(a)(1) or will otherwise be in compliance with other Nasdaq listing criteria.

Summary of Significant Accounting Policies - Summary of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation of Revenue [Line Items]
Total revenue	$ 4,170	$ 3,681
United States
Disaggregation of Revenue [Line Items]
Total revenue	2,248	2,023
Outside the United States
Disaggregation of Revenue [Line Items]
Total revenue	1,922	1,658
Disposables
Disaggregation of Revenue [Line Items]
Total revenue	3,426	3,211
Systems
Disaggregation of Revenue [Line Items]
Total revenue	0	0
Service/Other
Disaggregation of Revenue [Line Items]
Total revenue	$ 744	$ 470

- Definition

+ References

+ Details