The Surveyor Telemetry Central Station is designed to monitor up to 24 adult patients during cardiovascular problematic situations, through ambulatory transmitter sources. When used as a Telemetry Central Station System, Surveyor Central is designed to work with ECG only or multiparemeter transmitters for ECG and SpO2. For each patients ECG waveforms, HR, ST values and other parameters (if available) will be displayed.

The Mortara Surveyor Central Telemetry System is intended for centralized ECG monitoring of hospital patients connected to telemetry transmitters such as the Mortara X12 Ambulatory Telemetry Transmitter (K974149), (presently marketed as the X12+), or other compatible telemetry transmitters. Patients are (101-140), (produkt) manoving in a defined area, of a variable size depending on layout and thickness of walls. In order to guarantee a proper signal transmission in each different situation, an antenna network can be installed according to customer needs.

The cardiac data and analysis provided is reviewed, confirmed, and used by trained medical personnel in the diagnosis of patients with various rhythm patterns.

Indications for Use:

The Surveyor Central Telemetry System is indicated for use:

ECG monitoring of adult patients in Coronary Care Units, Step-Down Units, Emergency . Departments. It is not designed for use in highly invasive environments, such as an operating theatre.
Centralized ECG monitoring through a telemetry network of adult palients. Continuous analysis is . provided for all connected patients. It is not designed for use in highly invasive environments, such as an operating theatre.
Evaluation of adult patients with symptoms suggesting arrhythmia. Detected arrhythmias create an . audio-visual alarm according to the alarm profile.
. Chest Pain Evaluation.
Evaluation of adult patients with pacemakers. .
Evaluation of a patient's response after resuming occupational activities (e.g., after . M.I. or cardiac surgery.)
Evaluation of ECG documenting therapeutic interventions in individual patients or groups of . patients.
Clinical and epidemiological research studies.

Device Description

The Surveyor Telemetry Central Station is a diagnostic tool intended to acquire, and provide real time ECG data of patients that require ECG monitoring during cardiovascular problematic situations. The cardiac data provided is reviewed, confirmed, and used by trained medical personnel to assist in the diagnosis of patients with various rhythm patterns.

The Surveyor Telemetry Central Station will be used for centralized ECG monitoring in a telemetry system consisting of three main components: the ambulatory ECG telemetry transmitters (X12 Ambulatory Transmitters), the receivers combined with an antenna network and the Central Station software application running on a PC.

The transmitter is attached to the patient and acquires a continuous 12-lead ECG signal. The signal is A/D converted and digital data is sent to the Central Station using wireless radiofrequency communication.

The antenna network receives the data sent by the transmitters. The network delivers the signal to the receivers installed in the Central Station PC. The receivers decode the data containing the ECG waveforms and status from the transmitters.

The Central Station retrieves the data from the receivers and performs arrhythmia and ST analysis on the signal. The result of the analysis can trigger an audiovisual alarm. The priority of each arrhythmia and ST alarm is defined in the alarm profile.

When used as a Telemetry Central Station, Surveyor Central Station is designed to work with ECG only or multi-parameter transmitters for ECG and SpO2. The Central Station can simultaneously retrieve, display and analyze ECG signals for up to 24 patients.

A single patient can be selected for reviewing data in the single patient view, which includes following displayed and printed data:

All 12 real-time ECG leads. .
Current average and reference QRS complex with current ST levels for all leads .
The Central Station also stores waveforms, measurement data and alarms for 72 hours. The . waveforms can be reviewed and printed

AI/ML Overview

The provided text describes the Mortara Surveyor Telemetry Central Station, its intended use, and its classification, but it does not contain any information about acceptance criteria or specific studies proving device performance against such criteria.

The document is a 510(k) submission, primarily focused on establishing substantial equivalence to predicate devices and detailing the device's characteristics and intended use. It lists applicable standards (IEC 60601-1, ANSI/AAMI EC11-1991, etc.), which set general safety and performance requirements for medical electrical equipment, but it does not report any specific test results or performance metrics that would typically be used to demonstrate compliance with acceptance criteria.

Therefore, for each of your requested points, the information is not available in the provided text:

1. Table of acceptance criteria and the reported device performance

Acceptance Criteria	Reported Device Performance
Not specified	Not specified

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

Sample Size: Not specified.
Data Provenance: Not specified.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

Number of Experts: Not specified.
Qualifications of Experts: Not specified.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

Adjudication Method: Not specified.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

MRMC Study: Not mentioned. The device is a telemetry central station, not an AI-assisted diagnostic tool in the sense of image interpretation.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

Standalone Performance Study: Not mentioned or detailed. The document emphasizes that "The cardiac data and analysis provided is reviewed, confirmed, and used by trained medical personnel," indicating a human-in-the-loop system.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

Type of Ground Truth: Not specified.

8. The sample size for the training set

Sample Size: Not specified. No deep learning or AI model specific training is mentioned for which a training set would be defined.

9. How the ground truth for the training set was established

Ground Truth Establishment: Not specified.

In summary: The provided document is a 510(k) summary emphasizing device description, intended use, and substantial equivalence to predicate devices. It does not contain the detailed performance study results or acceptance criteria that would typically be found in a clinical validation report or similar technical documentation. The standards mentioned refer to general safety and performance, not specific performance criteria for the arrhythmia or ST analysis algorithms.

Summary

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K060135

510(k): Device Summary

Submitter:

Harlan Van Matre, Manager of Quality Assurance / Regulatory Affairs Mortara Instrument, Inc. 7865 N. 86" Street Milwaukee, WI 53224 (414) 354-4760 Fax: (414) 354-1600 Phone: Harlan Van Matre (see above) Contact:

Trade Name:	Surveyor Telemetry Central Station
Common Name:	Telemetry Central Station Monitor
Classification Name:	The following Class II classifications appear to be applicable:
Device Name	Classification Name	CFR Section
Surveyor Central Station	Electrocardiograph	870.2340
	Arrhythmia detector and alarm	870.1025
	Monitor, ST Segment with Alarm	870.1025
	Patient Physiological Monitor, (with arrhythmia detection or alarms)	870.1025

Legally marketed devices to which S. E. is claimed

The Surveyor Telemetry Central Station is an evolution of a legally marketed Mortara predicate device.

Mortara Model ST Central Station, (K922927) .
Datex-Ohmeda S/3 Telemetry Central System (K 000882) .

Description:

Page 1 of 3

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A single patient can be selected for reviewing data in the single patient view, which includes following displayed and printed data:

All 12 real-time ECG leads. .
Current average and reference QRS complex with current ST levels for all leads .
The Central Station also stores waveforms, measurement data and alarms for 72 hours. The . waveforms can be reviewed and printed

Intended Use:

The cardiac data and analysis provided is reviewed, confirmed, and used by trained medical personnel in the diagnosis of patients with various rhythm patterns.

Indications for Use:

The Surveyor Central Telemetry System is intended for ECG analysis in a clinical setting, by qualified medical professionals, properly trained for ECG monitoring and use of the system. The personnel must be experienced in cardiovascular problematic situations and emergency procedures or pathologies related to cardiac involvements

The Surveyor Central Telemetry System is indicated for use:

ECG monitoring of adult patients in Coronary Care Units, Step-Down Units, Emergency . Departments. It is not designed for use in highly invasive environments, such as an operating theatre.
Centralized ECG monitoring through a telemetry network of adult palients. Continuous analysis is . provided for all connected patients. It is not designed for use in highly invasive environments, such as an operating theatre.
Evaluation of adult patients with symptoms suggesting arrhythmia. Detected arrhythmias create an . audio-visual alarm according to the alarm profile.
. Chest Pain Evaluation.
Evaluation of adult patients with pacemakers. .
Evaluation of a patient's response after resuming occupational activities (e.g., after . M.I. or cardiac surgery.)
Evaluation of ECG documenting therapeutic interventions in individual patients or groups of . patients.
Clinical and epidemiological research studies. .

page 2 of 3

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Standards Data Form for Abbreviated 510(k)s

510(k) Number:

K060135

Standard Organization No: Or Standard Identification No:

IEC 60601-1 IEC 60601-1-1:2001 IEC 60601-1-4 A1:1999 ANSI/AAMI EC11-1991 ANSI/AAMI EC13:2002 (physiologic alarm) ANSI/AAMI EC57 :1998 UL 2601-01

Or CDRH Internal Reference No:

Declaration of Conformity Elements:
Any Adaptations Applied	yes	no	X
Any Requirements Not Applicable	yes	X	no
Any Deviations Applied	yes	no	X
Any Differences in Device Tested and Finished Product	yes	no	X
*Is There a Third Party or Test Lab Involved	yes	no	X

Was there another standard used in the review of this submission? yes X no

If another standard was used, please fill out an additional form.

This is not the third party that reviews 510ks

Page 3 of 3

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized depiction of an eagle or bird-like figure. The words "DEPARTMENT OF HEALTH AND HUMAN SERVICES. USA" are arranged in a circular pattern around the bird.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 15 2006

Mr. Harlan L. Van Matre Manager of Quality Assurance and Regulatory Affairs Mortara Instruments, Incorporated 7865 North 86th Street Milwaukee, Wisconsin 53224

Re: K060135

Trade/Device Name: Mortara Surveyor Telemetry Central Station Regulation Number: 21 CFR 870.1025 Regulation Name: Arrhythmia detector and alarm (including ST-segment measurement and alarm) Regulatory Class: Class II Product Code: MHX Dated: February 27, 2006 Received: April 27, 2006

Dear Mr. Van Matre:

We have reviewed your Section 510(k) premarket notification of intent to market the device w & nowe 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 101 use surved in the encrease 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), 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 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 Please be advised that FDA s issualled of a backan............................................................................................................................ that FDA has made a decemination administered by other Federal agencies. You must or any Federal statutes and regulations adminities as ut not limited to: registration and listing comply with all the Act STequirements, modaling, and manufacturing practice requirements as set
(21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing proctice the (2) CFR Part 807); labelling (21 CFR Pair 820); and if applicable, the electronic forth in the quality systems (Sections 531-542 of the Act); 21 CFR 100-1050.
product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. product faction control provisions (occions of revice as described in your Section 510(k)
This letter will allow you to begin marketing your device as described in your Secti I his letter will anow you to begin mankemily of substantial equivalence of your device to a legally premarket nothication. The PDA intallig of backership vour 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), please If you desire specific advice for your do not on the course note the regulation entitled, contact the Office of Comphance at (501) - 15 - 17 - 17 - 17 807.97). You may obtain "Misoranding by reference to promance roomans. The Act from the Division of Small
other general information on your responsibilities under the Act from the 1900 Call of 1900 other general international and Consumer Assistance at its toll-free number (800) 638-2041 or Mallulacturers, Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours,

Bhimima 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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Indications for Use

KU60135 510(k) Number (if known):

Device Name:

Mortara Surveyor Telemetry Central Station

Indications for Use:

The Surveyor Central Telemetry System is indicated for use:

in a clinical setting, by qualified medical professionals, properly trained for ECG monitoring . in a clinical setting, by qualificu modion propan are partients. The personnel must and use of the oyoten? Commilar problematic situations and emergency procedures or pathologies related to cardiac involvements.
centralized ECG monitoring through a telemetry network of adult patients in Coronary Care Contrailed EOO monitoring areasy Departments. It is not designed for use in highly invasive environments, such as an operating theatre.
Evaluation of adult patients with symptoms suggesting arrhythmia. Detected arrhythmias create an audiovisual alarm according to the alarm profile.
Chest Pain Evaluation.
Evaluation of adult patients with pacemakers.
Evaluation of a patient's response after resuming occupational or recreational activities (e.g. after M.I. or cardiac surgery.)
Evaluation of ECG documenting therapeutic interventions in individual patients or groups o patients.
Clinical and epidemiological research studies.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Us (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)

Blummenstons

(Division Sign-Off
Division of Cardiovascular Devices
510(k) Number K060135

Page 1 of __

Regulation Number and Section

§ 870.1025 Arrhythmia detector and alarm (including ST-segment measurement and alarm).

(a)
Identification. The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to produce a visible or audible signal or alarm when atrial or ventricular arrhythmia, such as premature contraction or ventricular fibrillation, occurs.(b)
Classification. Class II (special controls). The guidance document entitled “Class II Special Controls Guidance Document: Arrhythmia Detector and Alarm” will serve as the special control. See § 870.1 for the availability of this guidance document.