K Number
K120425
Device Name
PENTARAY NAV HIGH-DENSITY MAPPING CATHETER
Date Cleared
2012-05-24

(101 days)

Product Code
Regulation Number
870.1220
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Biosense Webster PENTARAY® NAV High-Density Mapping Catheter is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart. The PENTARAY® NAV High-Density Mapping Catheter provides location information when used with compatible CARTO® 3 EP Navigation Systems. (This catheter is not compatible with CARTO® 3 EP Navigation Systems prior to Version 3.0.)
Device Description
The PENTARAY® NAV High-Density Mapping Catheter is a 7 Fr, multi-electrode, electrophysiological diagnostic mapping catheter that consists of an array of five flexible ences that support a total of 20 Platinum/Iridium ring mapping electrodes (four electrodes per spine). The five spines converge at a multi-lumen soft tip section of the catheter that is deflectable (a minimum of 160°) and maneuverable by the user. These features permit positioning the flexible electrode-bearing spines against the heart wall to monitor positioning the nemore is an electromagnetic location sensor location sensor located within the soft tip of the shaft. Two new ring electrodes are positioned on the exterior of the shaft in this same area. The electrical wires from the 22 electrodes, the sensor, the puller wires that effect deflection, and a plastic tube for heparinized saline run through the length of the catheter shaft to the handle. The handle is used to advance or retract the catheter, torque the catheter, and/or deflect the catheter to optimize positioning of the multi-spined tip. The catheter is connected via appropriate cables to the CARTO® 3 EP Navigation System and/or appropriate recording equipment.
More Information

No
The summary describes a physical mapping catheter and its interaction with a navigation system, but there is no mention of AI or ML being used for data analysis, interpretation, or any other function. The focus is on the hardware and its ability to record electrograms and provide location information.

No.
The device is described as a diagnostic mapping catheter used for recording or stimulation, and obtaining electrograms. It is not intended for treating or curing a medical condition.

Yes
The device description explicitly states, "The PENTARAY® NAV High-Density Mapping Catheter is a 7 Fr, multi-electrode, electrophysiological diagnostic mapping catheter."

No

The device description clearly details a physical catheter with electrodes, a sensor, wires, and a handle, indicating it is a hardware device, not software-only.

Based on the provided information, the Biosense Webster PENTARAY® NAV High-Density Mapping Catheter is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use clearly states that the device is for "electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only." This involves interacting directly with the patient's body to measure electrical activity within the heart.
  • Device Description: The description details a catheter designed to be inserted into the heart to obtain electrograms. This is an invasive procedure performed in vivo (within a living organism).
  • Lack of In Vitro Activity: There is no mention of the device being used to test samples of human origin (like blood, tissue, or urine) outside of the body, which is the defining characteristic of an IVD.

IVD devices are used to examine specimens obtained from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device is used to directly measure electrical signals within the heart, which is an in vivo diagnostic procedure, not an in vitro one.

N/A

Intended Use / Indications for Use

The Biosense Webster PENTARAY® NAV High-Density Mapping Catheter is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart. The PENTARAY® NAV High-Density Mapping Catheter provides location information when used with compatible CARTO® 3 EP Navigation Systems. (This catheter is not compatible with CARTO® 3 EP Navigation Systems prior to Version 3.0.)

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

MTD

Device Description

The PENTARAY® NAV High-Density Mapping Catheter is a 7 Fr, multi-electrode, electrophysiological diagnostic mapping catheter that consists of an array of five flexible ences that support a total of 20 Platinum/Iridium ring mapping electrodes (four electrodes per spine). The five spines converge at a multi-lumen soft tip section of the catheter that is deflectable (a minimum of 160°) and maneuverable by the user. These features permit positioning the flexible electrode-bearing spines against the heart wall to monitor positioning the nemore is an electromagnetic location sensor location sensor located within the soft tip of the shaft. Two new ring electrodes are positioned on the exterior of the shaft in this same area. The electrical wires from the 22 electrodes, the sensor, the puller wires that effect deflection, and a plastic tube for heparinized saline run through the length of the catheter shaft to the handle. The handle is used to advance or retract the catheter, torque the catheter, and/or deflect the catheter to optimize positioning of the multi-spined tip. The catheter is connected via appropriate cables to the CARTO® 3 EP Navigation System and/or appropriate recording equipment.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cardiac structures in the heart, atrial and ventricular regions of the 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)

The PENTARAY® NAV High-Density Mapping Catheter underwent extensive Bench Testing that included simulated use conditions. After thorough investigations and mitigations where appropriate, the proposed catheter passed all intended criteria in accordance with appropriate test criteria and standards.

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.

K050217

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.

K081258

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

§ 870.1220 Electrode recording catheter or electrode recording probe.

(a)
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.(b)
Classification. Class II (performance standards).

0

MAY 2 4 2012

SECTION 2.

510(K) SUMMARY

K1204

2. 510(K) SUMMARY

This 510(k) Summary is being submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.

| APPLICANT | Biosense Webster, Inc.
3333 Diamond Canyon Road
Diamond Bar, CA 91765 |
|---------------------------|-------------------------------------------------------------------------------------------------------------------------------------|
| OFFICIAL
CORRESPONDENT | Wayne R. Hohman
Project Manager Regulatory Affairs
Telephone: 909-839-8597
Fax: 909-839-8804
Email: whohman@its.jnj.com |
| TRADE NAME | PENTARAY® NAV High-Density Mapping Catheter |
| COMMON NAME | Deflectable Tip Electrophysiology Catheter—Diagnostic |
| CLASSIFICATION NAME | Electrode recording catheter or electrode recording
probe |
| DEVICE CLASSIFICATION | Class II, 21 CFR §870.1220
Product Code: MTD |
| PRODUCT CODES | D-1282-01-S, D-1282-02-S, D-1282-03-S
D-1282-04-S, D-1282-05-S, D-1282-06-S |
| PREDICATE DEVICE | Biosense Webster Flower High-Density Mapping
Catheter (510(k) K050217), now named the PENTARAY®
High-Density Mapping Catheter |
| REFERENCE DEVICE | Biosense Webster LASSO® 2515 NAV Variable Catheter
(510(k) K081258) |

SUBSTANTIALLY EQUIVALENT TO:

PENTARAY® NAV High-Density Mapping Catheter is substantially equivalent to Biosense Webster's Flower High-Density Mapping Catheter (510(k) K050217), now named the PENTARAY® High-Density Mapping Catheter, and a Reference Device, the Biosense Webster Lasso 2515 NAV Variable Catheter (510(k) K081258). Like the predicate device, the PENTARAY® NAV High-Density Mapping Catheter features a fivespine array of 20 electrodes at the distal tip of a 7 Fr diameter catheter, has the same patient contact materials, and has the same device geometry. The original intended use of the predicate device for diagnosis of heart arrhythmias remains the same in the proposed

Biosense Webster, Inc. Pentaray NAV Catheters Traditional 510(k) Page 18 of 595

$\frac{1}{3}$

1

KI20425

device, however the proposed device will now have the added ability to provide location information when used with the CARTO® 3 EP Navigation System, Version 3.0. This latter capability is substantially equivalent to the Reference Device, the LASSO® 2515 NAV Variable Catheter. The LASSO® 2515 NAV Variable Catheter went through this same transition with FDA when FDA cleared the update of the non-navigational version to the navigational version.

DESCRIPTION OF THE DEVICE SUBJECT TO PREMARKET NOTIFICATION:

The PENTARAY® NAV High-Density Mapping Catheter is a 7 Fr, multi-electrode, electrophysiological diagnostic mapping catheter that consists of an array of five flexible ences that support a total of 20 Platinum/Iridium ring mapping electrodes (four electrodes per spine). The five spines converge at a multi-lumen soft tip section of the catheter that is deflectable (a minimum of 160°) and maneuverable by the user. These features permit positioning the flexible electrode-bearing spines against the heart wall to monitor positioning the nemore is an electromagnetic location sensor location sensor located within the soft tip of the shaft. Two new ring electrodes are positioned on the exterior of the shaft in this same area. The electrical wires from the 22 electrodes, the sensor, the puller wires that effect deflection, and a plastic tube for heparinized saline run through the length of the catheter shaft to the handle. The handle is used to advance or retract the catheter, torque the catheter, and/or deflect the catheter to optimize positioning of the multi-spined tip. The catheter is connected via appropriate cables to the CARTO® 3 EP Navigation System and/or appropriate recording equipment.

INDICATIONS FOR USE:

The Biosense Webster PENTARAY® NAV High-Density Mapping Catheter is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the attial and ventricular regions of the heart. The PENTARAY® NAV High-Density Mapping Catheter provides location information when used with compatible CARTO® 3 V3.0 EP Navigation Systems. (This catheter is not compatible with CARTO®3 EP Navigation Systems prior to Version 3.0.)

TECHNICAL CHARACTERISTICS:

The PENTARAY® NAV High-Density Mapping Catheter is a typical electrophysiological catheter that is unique only in its geometrical arrangement of 20 ring electrodes on five individual spines at its distal tip. Otherwise, there are no special technical aspects of the ability of this catheter to detect electrical signals from heart endocardium and transmit this information to the CARTO® 3 EP Navigation System and/or recording equipment for display, analysis, and interpretation in detection of various heart arrhythmias.

Biosense Webster, Inc. Pentaray NAV Catheters Traditional 510(k) Page 19 of 595

2

SECTION 2.

510(K) SUMMARY

PERFORMANCE DATA:

The PENTARAY® NAV High-Density Mapping Catheter underwent extensive Bench Testing that included simulated use conditions. After thorough investigations and mitigations where appropriate, the proposed catheter passed all intended criteria in accordance with appropriate test criteria and standards.

BASIS FOR DETERMINATION OF SUBSTANTIAL EQUIVALENCE:

A technological comparison and performance testing demonstrate that the PENTARAY® NAV High-Density Mapping Catheter is substantially equivalent to the predicate and reference devices.

Biosense Webster, Inc. Pentaray NA V Catheters

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the department's name around the perimeter. In the center of the circle is an abstract symbol that resembles an eagle or bird-like figure. The symbol is composed of three curved lines that form the body and wings of the bird.

Public Health Service

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

Biosense Webster, Inc. c/o Mr. Wayne Hohman Project Manager Regulatory Affairs 3333 Diamond Canyon Rd. Diamond Bar, CA 91765

MAY 2 4 2012

Re: K120425

Trade/Device Name: Pentaray Nav High-Density Mapping Catheter Regulation Number: 21 CFR §870.1220 Regulation Name: Catheter, Electrode Recording Regulatory Class: Class II (two) Product Code: MTD Dated: May 9, 2012 Received: May 10, 2012

Dear Mr. Hohman:

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.

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 or any Federal statutes and regulations administered by other Federal agencies. You must

4

Page 2 - Mr. Wayne Hohman

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 (QS) 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 (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Bram D. Zuckerman, M.D.

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

Enclosure

5

SECTION 1.

INDICATIONS FOR USE STATEMENT

1. INDICATIONS FOR USE STATEMENT

510(k) Number (if known)

Device Name: PENTARAY® NAV High-Density Mapping Catheter

Indications for Use:

The Biosense Webster PENTARAY® NAV High-Density Mapping Catheter is indicated for multiple electrode electrophysiological mapping of cardiac structures in the heart, i.e., recording or stimulation only. This catheter is intended to obtain electrograms in the atrial and ventricular regions of the heart. The PENTARAY® NAV High-Density Mapping Catheter provides location information when used with compatible CARTO® 3 EP Navigation Systems. (This catheter is not compatible with CARTO® 3 EP Navigation Systems prior to Version 3.0.)

Contraindications

  • The Biosense Webster PENTARAY® NAV High-Density Mapping Catheter has not . been shown to be safe and effective for radio frequency (RF) ablation.
  • Use of this catheter may not be appropriate for use in patients with prosthetic valves. A ● relative contraindication for cardiac catheter procedures is active systemic infection.
  • The transseptal approach is contraindicated in patients with intracardiac thrombus or ● myxoma, or interatrial baffle or patch.

Prescription Use X (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Cardiovascular Devices

510(k) NumberK120425
------------------------

Page 1 of 1· Biosense Webster, Inc PentaRay NAV Catheters

Traditional 510(k) (Replacement) Page 17 of 595