Cardioblate Pen Surgical Ablation Device, Cardioblate XL Pen Surgical Ablation Device

K190623 · Medtronic · OCL · May 30, 2019 · General, Plastic Surgery

Device Facts

• Record ID: K190623
• Device Name: Cardioblate Pen Surgical Ablation Device, Cardioblate XL Pen Surgical Ablation Device
• Applicant: Medtronic
• Product Code: OCL · General, Plastic Surgery
• Decision Date: May 30, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4400
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Cardioblate 49313 Surgical Ablation Pen: The Cardioblate surgical ablation pen is intended to ablate cardiac tissue during cardiac surgery using radiofrequency energy. Cardioblate 49314 XL Surgical Ablation Pen: The Cardioblate XL surgical ablation pen is intended to ablate cardiac tissue during cardiac surgery using radiofrequency energy.

Device Story

Handheld, single-use, monopolar RF ablation pens (Models 49313, 49314) for cardiac surgery. Devices feature integrated saline irrigation system to cool tissue at electrode-tissue interface during RF delivery. Operated by surgeons in clinical settings; used in conjunction with Valleylab FT10 Energy Platform (VLFT10GEN). RF energy creates lesions in cardiac tissue to treat arrhythmias. Irrigation prevents excessive heating. Output is controlled by the energy platform; surgeon monitors tissue contact and ablation progress visually. Benefits include precise, controlled cardiac tissue ablation.

Clinical Evidence

Bench testing only. No clinical or animal data required. Verification included mechanical, electrical, and electromagnetic compatibility testing per IEC 60601-1 and IEC 60601-2-2. Comparative lesion verification performed using soft tissue models to confirm ablation performance equivalence. Usability testing validated normal and worst-case use scenarios. Packaging validated per ISO 11607-1.

Technological Characteristics

Monopolar RF ablation pen; saline irrigation system; single-use; ethylene oxide sterilized. Connects to Valleylab FT10 Energy Platform. Complies with IEC 60601-1, IEC 60601-2-2, and IEC 60601-1-2. Dimensions/form factor: handheld pen. Connectivity: proprietary plug connector for energy platform.

Indications for Use

Indicated for patients undergoing cardiac surgery requiring cardiac tissue ablation via radiofrequency energy.

Regulatory Classification

Identification

An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.

Predicate Devices

• Cardioblate Monopolar Pens, Models 60813 and 60814 (K080509)

Reference Devices

• Valleylab™ FT10 Energy Platform, Model VLFT10GEN (K182610)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

May 30, 2019

Medtronic Rahul Shah Sr. Regulatory Affairs Specialist 7611 Northland Drive Minneapolis, Minnesota 55428

Re: K190623

Trade/Device Name: Cardioblate 49313 Surgical Ablation Pen, Cardioblate 49314 Surgical Ablation Pen Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: Class II Product Code: OCL Dated: April 2, 2019 Received: April 3, 2019

Dear Rahul Shah:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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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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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely.

Bram D. Zuckerman, M.D. Director OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K190623

#### Device Name

Cardioblate 49313 Surgical Ablation Pen Cardioblate 49314 XL Surgical Ablation Pen

Indications for Use (Describe)

Cardioblate 49313 Surgical Ablation Pen

The Cardioblate surgical ablation pen is intended to ablate cardiac surgery using radiofrequency energy.

Cardioblate 49314 XL Surgical Ablation Pen

The Cardioblate XL surgical ablation pen is intended to ablate cardiac surgery using radiofrequency energy.

| Type of Use (Select one or both, as applicable) |
|-------------------------------------------------|
|-------------------------------------------------|

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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# 510(k) Summary

| Date Prepared: | March 8, 2019 |
|--------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|
| Submitter: | Medtronic, Inc.<br>Medtronic Perfusion Systems<br>7611 Northland Drive<br>Minneapolis, MN 55428<br>Establishment Registration Number: 2184009 |
| Contact Person: | Rahul Shah<br>Senior Regulatory Affairs Specialist<br>Medtronic Perfusion Systems<br>Phone: [phone]<br>Email: [e-mail] |
| Alternate Contact: | Mike Green<br>Senior Regulatory Affairs Manager Medtronic<br>Perfusion Systems<br>Phone: [phone]<br>Email: [e-mail] |
| Device Name and Classification | |
| Trade Name: | Cardioblate 49313 Surgical Ablation Pen<br>Cardioblate 49314 XL Surgical Ablation Pen |
| Common Name: | Electrosurgical device |
| Classification name | Electrosurgical cutting and coagulation device and accessories |
| Classification: | Class II |
| Regulation Number: | 21 CFR 878.4400 |
| Product Code: | OCL |
| Name of Predicate Device | |
| K080509 | Cardioblate Monopolar Pens, Models 60813 and 60814 |
| Name of Reference Device | |

#### K182610 Valleylab™ FT10 Energy Platform, Model VLFT10GEN

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# Device Description

The Cardioblate Surgical Ablation devices (Pen and XL Pen, Model 49313 and 49314 respectively) are hand held, single use, monopolar, RF ablation devices for use in cardiac surgery. Each device has a saline irrigation system to deliver fluid at the contact point between the tissue and electrode tip to cool the tissue during RF energy delivery. The devices are intended for intermittent operation.

The proposed Cardioblate Pen and XL Pen devices are intended for use with the Valleylab™ FT10 Energy Platform (VLFT10GEN) with software version 3.0.0 or higher.

These devices are sterile, nonpyrogenic, disposable, and single use only. They are sterilized using ethylene oxide

## Indications for Use

#### Cardioblate Pen (49313)

The Cardioblate surgical ablation pen is intended to ablate cardiac tissue during cardiac surgery using radiofrequency energy.

#### Cardioblate XL Pen (49314)

The Cardioblate XL surgical ablation pen is intended to ablate cardiac tissue during cardiac surgery using radiofrequency energy.

### Comparison to Predicate Devices

When compared to predicate devices (K080509), the Cardioblate Surgical Ablation Devices (Pen and XL Pen) presented in this submission have the same:

- . Intended Use and Contraindications
- Technological characteristics and operating principle
- . Design features
- Performance specifications ●
- Patient contacting components and materials
- Shelf life

When compared to predicate devices (K080509), the Cardioblate Surgical Ablation Devices (Pen and XL Pen) presented in this submission have the following differences:

- . Cardioblate Monopolar (Pen and XL Pen) Devices
- New plug connector for VLFT10GEN compatibility
- IFU and Labeling updates ●
- . eIFU rather than paper IFU
- Cardioblate Monopolar (standard) Pen only .
- Packaging

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# Performance Testing

Performance testing was completed to demonstrate substantial equivalence of the system (the proposed Cardioblate surgical ablation devices (Pen and XL Pen), used with the Valleylab FT10 Energy Platform, software version 3.0 or higher) to the identified predicate system. Clinical and non-clinical animal testing was not required to establish substantial equivalence. The system components were subjected to the following verification testing, as applicable:

Mechanical: Mechanical verification testing was conducted for components of the subject devices to ensure compliance with current IEC 60601-1 and IEC 60601-2-2 standard requirements and Medtronic self-enforced requirements.

Electrical: Electrical verification testing was conducted for the subject devices to ensure compliance with current IEC 60601-1 and IEC 60601-2-2 electrical requirements.

Electromagnetic compatibility: Electromagnetic compatibility testing was completed for the subject devices to ensure compliance with current IEC 60601-1-2 standard requirements.

Benchtop Lesion Verification: Comparative lesion verification testing was performed using a soft tissue model to demonstrate the substantially equivalent ablation performance of the subject and predicate systems.

Usability: Testing was performed to verify and validate the usability requirements of the subject devices as a system. Elements captured included normal use cases, a foreseeable worst-case use scenario, and testable requirements for primary operating functions.

Packaging: Packaging sterile barrier system performance testing was conducted for the proposed devices in their final packaging in accordance with ISO 11607-1.

# Conclusion

Verification and validation test results demonstrate that the proposed devices are substantially equivalent to the predicates cleared in K080509. Differences between the proposed and predicate devices do not raise different questions of safety and effectiveness. The intended use of the devices has not changed. Moreover, the fundamental scientific technology, operating principle, and design features are unchanged from that of the predicate.

¹ The term 'substantially equivalent' as used herein is intended to be a determination of substantial equivalency under the Federal Food, Drug, and Cosmetic Act and relates to the fact that the product can be market approval or reclassification. Such a determination is not intended to have any bearing whatsoever on the resolution of patent infringement suits or other patent matters." (Federal Register, Vol. 42, No. 163, Aug. 23, 1977, page 42525 and 42529).