CLEARSIGN II Amplifier, 40 channels, CLEARSIGN II Amplifier, 80 channels, CLEARSIGN II Amplifier, 120 channels, CLEARSIGN II Amplifer, 160 channels

K150235 · Boston Scientific Corporation · DRQ · Apr 22, 2015 · Cardiovascular

Device Facts

• Record ID: K150235
• Device Name: CLEARSIGN II Amplifier, 40 channels, CLEARSIGN II Amplifier, 80 channels, CLEARSIGN II Amplifier, 120 channels, CLEARSIGN II Amplifer, 160 channels
• Applicant: Boston Scientific Corporation
• Product Code: DRQ · Cardiovascular
• Decision Date: Apr 22, 2015
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.2060
• Device Class: Class 2

Intended Use

The CLEARSIGN II Amplifier is intended to amplify and condition electrocardiographic signals of biologic origin and pressure transducer input, transmitting this information to a host computer (the LabSystem PRO EP Recording System) that can record and display the information.

Device Story

CLEARSIGN II Amplifier is a reusable electromedical device used in EP cath labs; operates as a signal acquisition and conditioning unit for the LabSystem PRO EP Recording System. Inputs include intracardiac/surface ECG signals and intravascular pressure transducer data. Device processes these signals and transmits them to the host computer for clinical selection, display, and recording. Used alongside EP catheters, stimulators, and ablation generators. Healthcare providers (physicians/technicians) use the displayed output to monitor cardiac activity and pressure during diagnostic and therapeutic EP procedures; facilitates real-time clinical decision-making during cardiac interventions.

Clinical Evidence

Bench testing and in vivo animal testing were performed. Bench testing included electrical safety (IEC 60601-1), electromagnetic compatibility (IEC 60601-1-2), software verification/validation (IEC 62304), drop/ship testing (ISTA 2A), and functional testing for invasive blood pressure (IEC 60601-2-34) and ECG monitoring (IEC 60601-2-27). Compatibility with the CARTO 3D system was also verified. All testing met pre-defined acceptance criteria.

Technological Characteristics

Reusable electromedical signal amplifier/conditioner. Compliance with IEC 60601-1 (3rd Ed), IEC 60601-1-2, IEC 60601-2-34, IEC 60601-2-27, and IEC 62304. Available in 40, 80, 120, and 160-channel configurations. Designed for integration with LabSystem PRO EP Recording System. RoHS compliant.

Indications for Use

Indicated for use during electrophysiology (EP) diagnostic and therapeutic procedures in an EP cath lab to amplify and condition electrocardiographic signals and pressure transducer inputs for recording and display.

Regulatory Classification

Identification

A transducer signal amplifier and conditioner is a device used to provide the excitation energy for the transducer and to amplify or condition the signal emitted by the transducer.

Predicate Devices

• CLEARSIGN (Borealis) Amplifier (K050006)

Reference Devices

• LabSystem Pro (LS PRO) EP Recording System (K141185)
• CARTO 3D navigation and mapping system

Submission Summary (Full Text)

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

April 22, 2015

Boston Scientific Corporation Maylin Truesdell, Senior Regulatory Affairs Specialist Electrophysiology Division 55 Technology Drive Lowell, MA 01851

Re: K150235

> Trade/Device Name: CLEARSIGN II Amplifier, with models 2002021, 2002022, 2002023 and 2002024 Regulatory Number: 21 CFR 870.2060 Regulation Name: Transducer Signal Amplifier and Conditioner Regulatory Class: Class II (Two) Product Code: DRO Dated: March 23, 2015 Received: March 24, 2015

Dear Ms. Truesdell:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 - Maylin Truesdell

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,


forBram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Attachment 2: Indications for Use Statement

### Indications for Use

510(k) Number (if known):_K150235____________________

Device Name: CLEARSIGN II Amplifier

#### Indications for Use:

The CLEARSIGN II Amplifier is intended to amplify and condition electrocardiographic signals of biologic origin and pressure transducer input, transmitting this information to a host computer (the LabSystem PRO EP Recording System) that can record and display the information.

#### Contraindications: None

Prescription Use × (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

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# Attachment 3: 510(k) Summary

### 510(k) Summary per 21 CFR §807.92

| Submitter's<br>Name and<br>Address | Boston Scientific Corporation<br>55 Technology Drive<br>Lowell, MA 01851<br>Phone: [phone]<br>Fax: [phone] |
|---------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Name<br>and<br>Information | Maylin Truesdell<br>Senior Regulatory Affairs Specialist<br>Phone: [phone]<br>Fax: [phone]<br>E-mail: [e-mail] |
| Date Prepared | January 28, 2015 |
| Proprietary<br>Name | CLEARSIGN II Amplifier |
| Model<br>Numbers | 2002021 CLEARSIGN II Amplifier, 40 channels<br>2002022 CLEARSIGN II Amplifier, 80 channels<br>2002023 CLEARSIGN II Amplifier, 120 channels<br>2002024 CLEARSIGN II Amplifier, 160 channels |
| Common Name | Transducer Signal Amplifier and Conditioner |
| Product Code | DRQ - Transducer Signal Amplifier and Conditioner |
| Classification | Class II, 21 CFR Part 870.2060 |
| Predicate<br>Devices | CLEARSIGN (Borealis) Amplifier<br>K050006, cleared May 27, 2005 |
| Device<br>Description | The LabSystem Pro (LS PRO) EP Recording System (K141185) with<br>CLEARSIGN/CLEARSIGN II Amplifier is an integrated system that<br>acquires, displays, records, and measures physiological signals that<br>originate from that heart. The CLEARSIGN II Amplifier is a reusable<br>electromedical device containing hardware and software that acquires,<br>conditions and presents the physiological signal to the LabSystem PRO<br>EP Recording System such that the signals are available for clinical user<br>selection, display and recording. The CLEARSIGN II Amplifier is used in<br>conjunction with the compatible diagnostic electrophysiology (EP)<br>catheters, surface ECG leads, intravascular pressure transducers,<br>intracardiac stimulators, RF ablation generators and cardiac ablation<br>catheters. The CLEARSIGN II Amplifier is intended for use during EP<br>diagnostic and therapeutic procedures in an EP cath lab. |
| Intended Use/<br>Indications for<br>Use | The CLEARSIGN II Amplifier is intended to amplify and condition<br>electrocardiographic signals of biologic origin and pressure transducer<br>input, transmitting this information to a host computer (the LabSystem<br>PRO EP Recording System) that can record and display the information. |
| Comparison of<br>Technological<br>Characteristics | The predicate device for this 510(k) Premarket Notification is the<br>CLEARSIGN (Borealis) Amplifier, K050006 cleared May 27, 2005. The<br>Indications for Use between the predicate, CLEARSIGN Amplifier, and the<br>proposed device, CLEARSIGN II Amplifier, are identical. The<br>CLEARSIGN II Amplifier incorporates fundamentally the same<br>technological characteristics as the predicate device. The basic<br>architecture and design of the hardware and software are the same; the<br>only changes are to bring the equipment to state-of-the-art (specifically,<br>compliance with IEC 60601-1, 3rd Edition), to comply with the EU RoHS<br>Directive, and to implement minor performance improvements. Therefore,<br>the CLEARSIGN II Amplifier is substantially equivalent to the predicate<br>device. |

CLEARSIGN II Amplifier Attachment 3, Page 1

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Performance Bench testing and in vivo testing were performed to support a determination of substantial equivalence. The CLEARSIGN II Amplifier is Data developed in accordance with 21 CFR 820.30 Quality System Regulation Design Controls. The device was developed and tested in accordance with the following industry standards: . IEC 60601-1, 310 Edition, Medical electrical equipment - Part 1: General requirements for basic safety and essential performance . IEC 60601-1-2 ed3.0 (2007-03). Medical electrical equipment -- Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests ● IEC 62304:2006, Medical device software - Software life-cycle processes ISO 14971:2012, Medical devices - Application of risk management to ● medical devices Testing conducted included: Electrical safety testing and assessment of risk management, in . accordance with IEC 60601-1, 3rd Edition ● Electro-magnetic compatibility (emissions and immunity) testing, in accordance with IEC 60601-1-2, 300 Edition ● Software verification and validation including software lifecycle assessment per ISO 62304 and FDA quidelines ● Drop/ship testing, per ISTA 2A requirements . Testing of specific functions, including the invasive blood pressure function (per IEC 60601-2-34) and the electrocardiographic monitoring function (per IEC 60601-2-27) . Operational temperature and atmospheric environment testing . Testing for compatibility with the CARTO 3D navigation and mapping system (Biosense Webster, Diamond Bar, CA), as LabSystem PRO is labeled for use with CARTO . In vivo animal testing All testing met pre-defined acceptance criteria, thus confirming the safety and effectiveness of each functional aspect of the CLEARSIGN II Amplifier. The results of these tests provide reasonable assurance that the proposed device has been designed and tested to assure conformance to the requirements for its intended use. No new safety or performance issues were raised during the device testing. Conclusion Based on the idential indications for use, substantially equivalent technological characteristics, and safety and performance testing, the CLEARSIGN II Amplifier has been shown to be appropriate for its intended use and is considered to be substantially equivalent to the CLEARSIGN (Borealis) Amplifier as submitted in K050006.