Reprocessed Webster CS Bi-Directional Diagnostic EP Catheter, Reprocessed Webster CS Bi-Directional Diagnostic EP Catheter (with Auto ID)

K170922 · Innovative Health, LLC · NLH · Jun 22, 2017 · Cardiovascular

Device Facts

• Record ID: K170922
• Device Name: Reprocessed Webster CS Bi-Directional Diagnostic EP Catheter, Reprocessed Webster CS Bi-Directional Diagnostic EP Catheter (with Auto ID)
• Applicant: Innovative Health, LLC
• Product Code: NLH · Cardiovascular
• Decision Date: Jun 22, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.1220
• Device Class: Class 2

Intended Use

The Reprocessed Webster CS Bi-directional Diagnostic EP Catheter is indicated for electrophysiological mapping of cardiac structures, i.e. stimulation and recording only. The catheter is designed for use in the coronary sinus.

Device Story

Steerable, multi-electrode catheter used for electrophysiological mapping of heart; specifically coronary sinus. Features high-torque shaft, bi-directional deflectable tip, platinum electrode array. Operated by physician in clinical setting. Tip deflection controlled via rocker lever; shaft rotation allows precise positioning. Models with Auto ID technology contain EEPROM storing unique identification data, readable by CARTO EP Navigation Systems. Device facilitates cardiac stimulation and recording; output used by clinicians to map cardiac electrical activity. Reprocessed device; limited to one reprocessing cycle; includes cleaning, decontamination, inspection, and functional testing.

Clinical Evidence

Bench testing only. Testing included biocompatibility, cleaning and sterilization validation, visual inspection, dimensional verification, electrical continuity/resistance, simulated use, mechanical characteristics, Auto ID verification, electrical safety (dielectric and current leakage), and packaging validation.

Technological Characteristics

7FR catheter, 115cm usable length. Materials include platinum electrodes, braided deflectable tip. Features rocker lever for deflection, high-torque shaft. Auto ID models include EEPROM for identification. Connectivity via interface cables to CARTO EP Navigation Systems. Reprocessed device; sterilization validation performed.

Indications for Use

Indicated for electrophysiological mapping (stimulation and recording) of cardiac structures, specifically the coronary sinus.

Regulatory Classification

Identification

An electrode recording catheter or an electrode recording probe is a device used to detect an intracardiac electrocardiogram, or to detect cardiac output or left-to-right heart shunts. The device may be unipolar or multipolar for electrocardiogram detection, or may be a platinum-tipped catheter which senses the presence of a special indicator for cardiac output or left-to-right heart shunt determinations.

Predicate Devices

• Webster CS Catheter with EZ Steer Technology, Webster CS Catheter with EZ Steer Technology and Auto ID (K101345)

Submission Summary (Full Text)

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

June 22, 2017

Innovative Health, LLC. Amy Stoklas-Oakes Sr. Quality and Regulatory Manager 1435 North Hayden Road, Suite 100 Scottsdale, Arizona 85257

Re: K170922

Trade/Device Name: Reprocessed Webster CS Bi-Directional Diagnostic Electrophysiology (EP) Catheters (see list of models enclosed)

Regulation Number: 21 CFR 870.1220 Regulation Name: Electrode Recording Catheter or Electrode Recording Probe Regulatory Class: Class II Product Code: NLH Dated: May 31, 2017 Received: June 1, 2017

Dear Amy Stoklas-Oakes:

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.

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

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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 of medical devicerelated 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 contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely.

M.A. Hillemann

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

Enclosure

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| Item Number | Description | Sheath<br>Usable<br>Length<br>(cm) | French<br>Size | Curve | Spacing<br>(mm) |
|---------------|---------------------------------------------------------------------|------------------------------------|----------------|-------|-----------------|
| BD710DF282RTS | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter | 115 | 7F | D-F | 2-8-2 |
| BD710FJ282RTS | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter | 115 | 7F | F-J | 2-8-2 |
| BD710DF282CT | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter with Auto ID | 115 | 7F | D-F | 2-8-2 |
| BD710FJ282CT | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter with Auto ID | 115 | 7F | F-J | 2-8-2 |

The following device models are included in this 510(k) submission:

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# Indications for Use

510(k) Number (if known)

K170922

#### Device Name

Reprocessed Webster CS Bi-directional Diagnostic Electrophysiology (EP) Catheters

Indications for Use (Describe)

The Reprocessed Webster CS Bi-directional Diagnostic EP Catheter is indicated for electrophysiological mapping of cardiac structures, i.e. stimulation and recording only. The catheter is designed for use in the coronary sinus.

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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# SECTION 5: 510(k) SUMMARY

As required by 21 CFR 807.92(c)

#### Submitter's Name and Address:

Innovative Health, LLC. 1435 N. Hayden Road, Suite 100 Scottsdale, AZ 85257

#### Contact Name and Information:

Amy Stoklas-Oakes Innovative Health, LLC. Sr. Quality and Requlatory Manager [phone] (office) [phone] (fax) [e-mail]

### Date prepared:

March 28, 2017

# Device Information:

Trade/Proprietary Name:

Common Name: Classification Name: Classification Number: Product Code:

Reprocessed Webster CS Bi-directional Diagnostic Electrophysiology (EP) Catheters Diagnostic Electrophysiology Catheter Catheter, Recording, Electrode, Reprocessed Class II, 21 CFR 870.1220 NLH

#### Predicate Device:

| 510(k) Number | 510(k) Title | Manufacturer |
|---------------|--------------------------------------------------------------------------------------------------------------|------------------|
| K101345 | Webster CS Catheter with EZ Steer<br>Technology, Webster CS Catheter with<br>EZ Steer Technology and Auto ID | Biosense Webster |

#### Device Description:

The Reprocessed Webster Coronary Sinus (CS) Diagnostic Electrophysiology (EP) Catheter is a steerable, multi-electrode catheter with a deflectable tip designed to facilitate electrophysiological mapping of the heart. The device is a 7FR catheter with a usable length of 115cm. The catheter has a high-torque shaft with a bi-directional deflectable tip section containing an array of platinum electrodes that can be used for stimulation and recording.

Standard features of this catheter include a braided bi-directional deflectable tip section with an array of platinum electrodes that includes a 2mm tip dome. Additionally, two asymmetric curve types are available providing two 180º opposed, single plane curves. The curve types include DF and FJ. A Rocker Lever is used to deflect the tip. The hightorque shaft allows the plane of the curved tip to be rotated to facilitate accurate positioning of the catheter tip at the desired site.

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# For Devices with Auto ID Technology:

The catheter is equipped with Electronically Erasable Programmable Read Only Memory (EEPROM) which is used to store unique catheter identification information. CARTO EP Navigation Systems equipped with Auto ID Technology can access the stored information and automatically recognize he catheter information.

The catheter interfaces with CARTO EP Navigation Systems equipped with Auto ID Technology via interface cables with the appropriate connectors.

Note: Only the catheter is the subject of this submission. Any other related equipment is not included in the scope of this submission.

| Item Number | Description | Sheath<br>Usable<br>Length<br>(cm) | French<br>Size | Curve | Spacing<br>(mm) |
|---------------|---------------------------------------------------------------------|------------------------------------|----------------|-------|-----------------|
| BD710DF282RTS | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter | 115 | 7F | D-F | 2-8-2 |
| BD710FJ282RTS | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter | 115 | 7F | F-J | 2-8-2 |
| BD710DF282CT | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter with Auto ID | 115 | 7F | D-F | 2-8-2 |
| BD710FJ282CT | Webster CS<br>Bi-Directional Diagnostic<br>EP Catheter with Auto ID | 115 | 7F | F-J | 2-8-2 |

The item numbers included in the scope of this submission are as follows:

Table 5.1: Item Numbers

# Indications for Use:

The Reprocessed Webster CS Bi-directional Diagnostic EP Catheter is indicated for electrophysiological mapping of cardiac structures, i.e. stimulation and recording only. The catheter is designed for use in the coronary sinus.

# Technological Characteristics:

The purpose, design, materials, function, and intended use of the Webster CS Bidirectional Diagnostic EP Catheters are identical to the predicate devices. There are no changes to the claims, clinical applications, patient population, performance specifications, or method of operation. In addition, Innovative Health's reprocessing of these devices includes removal of visible soil and decontamination. Each device is inspected and function tested prior to packaging and labeling.

# Functional and Safety Testing:

Bench and laboratory testing was conducted to demonstrate performance (safety and effectiveness) of the Reprocessed Webster CS Bi-directional Diagnostic EP Catheters.

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This included the following:

- Biocompatibility ●
- Cleaning Validation ●
- Sterilization Validation .
- Functional Testing ●
- Visual Inspection ●
- Dimensional Verification ●
- Electrical Continuity and Resistance ●
- Simulated Use ●
- Mechanical Characteristics .
- Auto ID Verification
- Electrical Safety Testing
- Dielectric and Current Leakage .
- . Packaging Validation

The Reprocessed Webster Coronary Sinus (CS) Bi-directional Diagnostic Electrophysiology (EP) Catheters are reprocessed no more than one (1) time. Each device is marked and tracked. After the device has reached the maximum number of reprocessing cycles, the device is rejected from further reprocessing is performed only by Innovative Health. Innovative Health restricts its reprocessing to exclude devices previously reprocessed by other reprocessors.

# Conclusion:

.

Innovative Health concludes that the Reprocessed Webster Coronary Sinus (CS) Bidirectional Diagnostic Electrophysiology (EP) Catheters are as safe and effective as the predicate devices described herein.