K Number
K012460
Device Name
MODEL 6495 BIPOLAR TEMPORARY MYOCARDIAL PACING LEAD
Manufacturer
Date Cleared
2001-08-14

(13 days)

Product Code
Regulation Number
870.3680
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Model 6495 Bipolar Temporary Myocardial Pacing Lead is designed for temporary atrial and ventricular pacing and sensing for a contemplated implant duration of 7 days or less. The device is supplied sterile and intended for single use only.
Device Description
The Model 6495 Bipolar Temporary Myocardial Pacing Lead consists of an insulated multi-filament lead, which contains a distal, discrete, ring electrode, a discrete, tip electrode, and a coaxial conductor lead body. Each discrete electrode is crimped onto a conductor and terminates in an atraumatic myocardial curved needle. A blue monofilament coil provides fixation while the lead is implanted in myocardial tissue. An atraumatic chest needle at the proximal end of the conductor wire permits exiting the pacing lead through the chest wall. Terminated on the back of the chest needle are two breakaway connector pins. To remove the pacing lead, gentle traction should be applied. No part of the lead remains in the body.
More Information

Not Found

Not Found

No
The description focuses on the physical components and electrical properties of a temporary pacing lead, with no mention of AI or ML capabilities. The performance studies are based on compatibility testing of physical and electrical characteristics.

Yes
The device is described as a "Temporary Myocardial Pacing Lead" designed for "temporary atrial and ventricular pacing," which directly indicates a therapeutic function.

No

The device is designed for temporary pacing and sensing, which are therapeutic and monitoring functions, not diagnostic. While it performs "sensing," this is for pacing purposes, not to diagnose a condition.

No

The device description clearly details physical components like electrodes, needles, and lead bodies, indicating it is a hardware device, not software-only.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Model 6495 Bipolar Temporary Myocardial Pacing Lead is a device that is inserted into the body (myocardial tissue) to provide temporary electrical pacing and sensing. It does not analyze samples taken from the body.
  • Intended Use: The intended use clearly states "temporary atrial and ventricular pacing and sensing," which is an in-vivo (within the living body) function, not an in-vitro (in glass/outside the body) function.

Therefore, based on the provided information, the Model 6495 Bipolar Temporary Myocardial Pacing Lead is a medical device but not an IVD.

N/A

Intended Use / Indications for Use

The Model 6495 Bipolar Temporary Myocardial Pacing Lead is designed for temporary atrial and ventricular pacing and sensing for a contemplated implant duration of 7 days or less. The device is supplied sterile and intended for single use only.

Product codes (comma separated list FDA assigned to the subject device)

74 LDF

Device Description

The Model 6495 Bipolar Temporary Myocardial Pacing Lead consists of an insulated multi-filament lead, which contains a distal, discrete, ring electrode, a discrete, tip electrode, and a coaxial conductor lead body. Each discrete electrode is crimped onto a conductor and terminates in an atraumatic myocardial curved needle. A blue monofilament coil provides fixation while the lead is implanted in myocardial tissue. An atraumatic chest needle at the proximal end of the conductor wire permits exiting the pacing lead through the chest wall. Terminated on the back of the chest needle are two breakaway connector pins. To remove the pacing lead, gentle traction should be applied. No part of the lead remains in the body.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

myocardial tissue (heart)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Medtronic, Inc. performed system compatibility testing to support that the Model Mcdirolie, the perfective syocardial Pacing lead is equivalent to the predicate device. Device testing included:

  • Environmental Conditioning .
  • Visual Verification .
  • Dimensional Testing .
  • Electrical Testing .
  • Mechanical Testing .
    All system compatibility tests performed have demonstrated that the modified Model 6495 heartwire meets the specified requirements.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

The production and the currently market released Model 6495 Bipolar Temporary Myocardial Pacing Lead. (K-number not specified in the text as is typically seen for predicate devices)

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 870.3680 Cardiovascular permanent or temporary pacemaker electrode.

(a)
Temporary pacemaker electrode —(1)Identification. A temporary pacemaker electrode is a device consisting of flexible insulated electrical conductors with one end connected to anexternal pacemaker pulse generator and the other end applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator.(2)
Classification. Class II (performance standards).(b)
Permanent pacemaker electrode —(1)Identification. A permanent pacemaker electrode is a device consisting of flexible insulated electrical conductors with one end connected to an implantable pacemaker pulse generator and the other end applied to the heart. The device is used to transmit a pacing electrical stimulus from the pulse generator to the heart and/or to transmit the electrical signal of the heart to the pulse generator.(2)
Classification. Class III (premarket approval).(c)
Date PMA or notice of completion of PDP is required. A PMA or notice of completion of a PDP is required to be filed with the Food and Drug Administration on or before October 4, 2012, for any permanent pacemaker electrode device that was in commercial distribution before May 28, 1976, or that has, on or before October 4, 2012, been found to be substantially equivalent to any permanent pacemaker electrode device that was in commercial distribution before May 28, 1976. Any other pacemaker repair or replacement material device shall have an approved PMA or declared completed PDP in effect before being placed in commercial distribution.

0

K012460 p. 1/3

MEDTRONIC CONFIDENTIAL

Special 510(k) Premarket Notification Model 6495 Bipolar Temporary Myocardial Pacing Lead Attachment D: 510(k) Summary of Substantial Equivalence

AUG 1 4 2001

ATTACHMENT D 510(K) SUMMARY OF SUBSTANTIAL EQUIVALENCE

Submitter

Medtronic, Inc. 7000 Central Avenue N.E. Minneapolis, MN 55432

Contact: Tina Benoit, Associate Product Regulation Manager Telephone: (763) 514-4112 Fax: (763) 514-6424 E-Mail: tina.benoit@medtronic.com

Date Prepared: July 31, 2001

Name of Device

Trade Name: Temporary Pacemaker Electrode, 74 LDF Common Name: Temporary Pacing Lead Classification: Class II

1

K012460 p. 2/3

MEDTRONIC CONFIDENTIAL

Special 510(k) Premarket Notification Model 6495 Bipolar Temporary Myocardial Pacing Lead Model 6495 Dipolar \ Summary of Substantial Equivalence

Predicate Devices

The predicate device for the Model 6495 Bipolar Temporary Myocardial Pacing The production and the currently market released Model 6495 Bipolar Temporary Myocardial Pacing Lead.

Device Description

The Model 6495 Bipolar Temporary Myocardial Pacing Lead consists of an insulated multi-filament lead, which contains a distal, discrete, ring electrode, a discrete, tip electrode, and a coaxial conductor lead body. Each discrete electrode is crimped onto a conductor and terminates in an atraumatic myocardial curved needle. A blue monofilament coil provides fixation while the lead is implanted in myocardial tissue. An atraumatic chest needle at the proximal end of the conductor wire permits exiting the pacing lead through the chest wall. Terminated on the back of the chest needle are two breakaway connector pins. To remove the pacing lead, gentle traction should be applied. No part of the lead remains in the body.

Packaging

The sterile packaging for the Model 6495 Bipolar Temporary Myocardial Pacing Lead consists of a double pouch configuration. The inner pouch (or package liner) and outer pouch materials are transparent Tyvek - polyester/polyethylene laminate. The pouches are heat-sealed.

Intended Use

The Model 6495 Bipolar Temporary Myocardial Pacing Lead is designed for temporary atrial and ventricular pacing and sensing for a contemplated implant duration of 7 day or less. The device is supplied sterile and intended for single use only.

Technological Characteristics

The technology used with the Model 6495 Bipolar Temporary Myocardial Pacing Lead is the same technological characteristics as the predicate device.

2

K012460 p.3/3

MEDTRONIC CONFIDENTIAL

Special 510(k) Premarket Notification Model 6495 Bipolar Temporary Myocardial Pacing Lead Model 0435 Dipolar > Substantial Equivalence

Summary of Studies

Medtronic, Inc. performed system compatibility testing to support that the Model Mcdirolie, the perfective syocardial Pacing lead is equivalent to the predicate device. Device testing included:

  • Environmental Conditioning .
  • Visual Verification .
  • Dimensional Testing .
  • Electrical Testing .
  • Mechanical Testing .

All system compatibility tests performed have demonstrated that the modified Model 6495 heartwire meets the specified requirements.

Sterilization Validation

The Model 6495 Bipolar Temporary Myocardial Pacing Lead is sterilized using a The Model 6495 Dipolar Tomporilization process. Processes appropriate for sterilizing the devices were validated.

Conclusion

Through data and information presented, numerous similarities support a I hrough data and information pivalence and show the device modifications do not determination of bactuation equive or alter the fundamental scientific technology of the device. Market clearance of the Model 6495 Bipolar Temporary Myocardial Pacing Lead is supported through this Special 510(k) Premarket Notification.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Image /page/3/Picture/2 description: The image is a logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the circle is an image of an eagle with its wings spread.

AUG 1 4 2001

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Tina L. Benoit Medtronic, Inc. Cardiac Rhythm Management 7000 Central Avenue NE Minneapolis, MN 55432-3576

Re: K012460

Trade Name: Model 6495 Bipolar Temporary Myocardial Pacing Lead Regulation Number: 21 CFR 870.3680 Regulatory Class: Class II (two) Product Code: 74 LDF Dated: July 31, 2001 Received: August 1, 2001

Dear Ms. Benoit:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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). 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.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this

4

Page 2 - Ms. Tina L. Benoit

response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed nredicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4646. Additionally, for questions on the promotion and advertising of your device, (1) be se contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

Oakteh
James E. Dillard III

Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Special 510(k) Premarket Notification Model 6495 Bipolar Temporary Myocardial Pacing Lead Indications for Use

INDICATIONS FOR USE

NA KO 12460

510(k) Number (if known):

Device Name:

Medtronic® Model 6495 Bipolar Temporary Myocardial Pacing Lead

Indications For Use:

The Model 6495 Bipolar Temporary Myocardial Pacing Lead is designed for temporary atrial and ventricular pacing and sensing for a contemplated implant duration of 7 days or less. The device is supplied sterile and intended for single use only.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

Division of Cardiovascular & Respiratory Devices
510(k) Number K012460

(Optional Format 1-2-96)