K Number
K150246
Device Name
Medtronic Model 5392 External Pulse Generator (EPG)
Manufacturer
Date Cleared
2015-02-18

(16 days)

Product Code
Regulation Number
870.3600
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The temporary pacemaker is used with a cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment by trained personnel. The temporary pacemaker can be used where short-term demand (synchronous) or asynchronous pacing is indicated for therapeutic, prophylactic or diagnostic purposes. The temporary pacemaker must be used in an environment where the patient is monitored continuously to ensure that it is operating properly and delivering appropriate therapy to the patient. Specific indications for temporary cardiac pacing include, but are not limited to, the following: - Complete heart block - Sinus bradycardia - Sick sinus syndrome - Bradycardia with congestive heart failure - Atrial and/or ventricular arrhythmias - Cardiac arrest - Support, management, and evaluation of a patient prior to permanent pacemaker Implantation - Support during permanent pacemaker replacement - Cardiac complications during invasive or surgical procedures - Support following cardiac surgery - Acute myocardial infarction complicated by heart block - Atrial tachyarrhythmias that require high-rate burst pacing for treatment
Device Description
The Model 5392 EPG is a battery-powered, dual chamber, temporary pacemaker designed primarily for temporary antibradycardia pacing therapy. The 53922 EPG cover accessory is an optional disposable protective cover to reduce accidental activation of the controls of the 5392 EPG.
More Information

Not Found

No
The document describes a standard temporary pacemaker and does not mention any AI or ML capabilities. The "Mentions AI, DNN, or ML" section explicitly states "Not Found".

Yes
The device is indicated for "therapeutic, prophylactic or diagnostic purposes" and "delivering appropriate therapy to the patient" for various cardiac conditions.

Yes
The "Intended Use / Indications for Use" section explicitly states that the temporary pacemaker can be used for "diagnostic purposes."

No

The device description explicitly states it is a "battery-powered, dual chamber, temporary pacemaker" and mentions a "cover accessory," indicating it is a physical hardware device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The description clearly states that this device is a "temporary pacemaker" and an "External Pulse Generator (EPG)". Its function is to provide electrical stimulation to the heart for pacing purposes. This is a therapeutic intervention performed on the patient, not a test performed on a sample from the patient.
  • Intended Use: The intended use describes the device being used with a "cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment". This directly relates to treating or supporting the heart's electrical activity, not analyzing a biological sample.

The information provided consistently points to this being a therapeutic medical device used for direct patient care, not an in vitro diagnostic device used for testing biological samples.

N/A

Intended Use / Indications for Use

The temporary pacemaker is used with a cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment by trained personnel. The temporary pacemaker can be used where short-term demand (synchronous) or asynchronous pacing is indicated for therapeutic, prophylactic or diagnostic purposes. The temporary pacemaker must be used in an environment where the patient is monitored continuously to ensure that it is operating properly and delivering appropriate therapy to the patient.

Specific indications for temporary cardiac pacing include, but are not limited to, the following:

  • Complete heart block
  • Sinus bradycardia
  • Sick sinus syndrome
  • Bradycardia with congestive heart failure
  • Atrial and/or ventricular arrhythmias
  • Cardiac arrest
  • Support, management, and evaluation of a patient prior to permanent pacemaker Implantation
  • Support during permanent pacemaker replacement
  • Cardiac complications during invasive or surgical procedures
  • Support following cardiac surgery
  • Acute myocardial infarction complicated by heart block
  • Atrial tachyarrhythmias that require high-rate burst pacing for treatment

Product codes

DTE

Device Description

The Model 5392 EPG is a battery-powered, dual chamber, temporary pacemaker designed primarily for temporary antibradycardia pacing therapy. The 53922 EPG cover accessory is an optional disposable protective cover to reduce accidental activation of the controls of the 5392 EPG.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

The temporary pacemaker is used with a cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment by trained personnel.

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

Technological differences between the subject and predicate devices have been evaluated through bench tests to provide evidence of safe and effective use. The device design and materials have been verified through regression bench testing to product level performance requirements. The results of the verification tests met the specified acceptance criteria and did not raise new safety or performance issues.

Key Metrics

Not Found

Predicate Device(s)

Medtronic Model 5392 External Pulse Generator (EPG) K132924

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.3600 External pacemaker pulse generator.

(a)
Identification. An external pacemaker pulse generator (EPPG) is a prescription device that has a power supply and electronic circuits that produce a periodic electrical pulse to stimulate the heart. This device, which is used outside the body, is used as a temporary substitute for the heart's intrinsic pacing system until a permanent pacemaker can be implanted, or to control irregular heartbeats in patients following cardiac surgery or a myocardial infarction. The device may have adjustments for impulse strength, duration, R-wave sensitivity, and other pacing variables.(b)
Classification. Class II (special controls). The special controls for this device are:(1) Appropriate analysis/testing must validate electromagnetic compatibility (EMC) within a hospital environment.
(2) Electrical bench testing must demonstrate device safety during intended use. This must include testing with the specific power source (
i.e., battery power, AC mains connections, or both).(3) Non-clinical performance testing data must demonstrate the performance characteristics of the device. Testing must include the following:
(i) Testing must demonstrate the accuracy of monitoring functions, alarms, measurement features, therapeutic features, and all adjustable or programmable parameters as identified in labeling;
(ii) Mechanical bench testing of material strength must demonstrate that the device and connection cables will withstand forces or conditions encountered during use;
(iii) Simulated use analysis/testing must demonstrate adequate user interface for adjustable parameters, performance of alarms, display screens, interface with external devices (
e.g. data storage, printing), and indicator(s) functionality under intended use conditions; and(iv) Methods and instructions for cleaning the pulse generator and connection cables must be validated.
(4) Appropriate software verification, validation, and hazard analysis must be performed.
(5) Labeling must include the following:
(i) The labeling must clearly state that these devices are intended for use in a hospital environment and under the supervision of a clinician trained in their use;
(ii) Connector terminals should be clearly, unambiguously marked on the outside of the EPPG device. The markings should identify positive (+) and negative (−) polarities. Dual chamber devices should clearly identify atrial and ventricular terminals;
(iii) The labeling must list all pacing modes available in the device;
(iv) Labeling must include a detailed description of any special capabilities (
e.g., overdrive pacing or automatic mode switching); and(v) Appropriate electromagnetic compatibility information must be included.

0

Public Health Service

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

February 19, 2015

Medtronic, Inc. c/o Becky Severson Sr. Regulatory Associate 8200 Coral Sea Street NE Mounds View, Minnesota 55112

Re: K150246

Trade/Device Name: Medtronic Model 5392 External Pulse Generator (EPG) Regulation Number: 21 CFR 870.3600 Regulation Name: External Pacemaker Pulse Generator Regulatory Class: Class III Product Code: DTE Dated: January 30, 2015 Received: February 2, 2015

Dear Becky Severson,

This letter corrects our substantially equivalent letter of February 18, 2015.

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

1

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

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

Sincerely yours,

M.A. Hillebrand

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

Enclosure

2

Indications for Use

510(k) Number: K150246

Device Name: Medtronic Model 5392 External Pulse Generator (EPG)

Indications for Use: The temporary pacemaker is used with a cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment by trained personnel. The temporary pacemaker can be used where short-term demand (synchronous) or asynchronous pacing is indicated for therapeutic, prophylactic or diagnostic purposes. The temporary pacemaker must be used in an environment where the patient is monitored continuously to ensure that it is operating properly and delivering appropriate therapy to the patient.

Specific indications for temporary cardiac pacing include, but are not limited to, the following:

  • Complete heart block ●
  • Sinus bradycardia ●
  • Sick sinus syndrome ●
  • Bradycardia with congestive heart failure ●
  • Atrial and/or ventricular arrhythmias
  • Cardiac arrest
  • Support, management, and evaluation of a patient prior to permanent pacemaker ● Implantation
  • Support during permanent pacemaker replacement ●
  • Cardiac complications during invasive or surgical procedures
  • Support following cardiac surgery ●
  • Acute myocardial infarction complicated by heart block ●
  • o Atrial tachyarrhythmias that require high-rate burst pacing for treatment

Prescription Use _ X__________AND/OR Over-The-Counter Use (Part 21 CFR 801 Subpart D) (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

3

510(k) Summary 2

[As required by 21 CFR 807.92]

Date Prepared:January 30, 2015
Submitter:Medtronic, Inc.
Medtronic Cardiac Rhythm Heart Failure
8200 Coral Sea Street N.E.
Mounds View, MN 55112
Establishment Registration Number: 2182208
Contact Person:Becky Severson
Senior Regulatory Affairs Specialist
Medtronic Cardiac Rhythm Heart Failure
Phone: 763.526.2365
Fax: 651.367.0603
Email: becky.t.severson@medtronic.com
Alternate Contact:Ryan Calabrese
Director Regulatory Affairs
Medtronic Cardiac Rhythm Heart Failure
Phone: 763.526.3515
Fax: 651.367.0603
Email: ryan.s.calabrese@medtronic.com

General Information

Trade Name:Medtronic Model 5392 External Pulse Generator (EPG)
Common Name:External pacemaker pulse generator
Regulation Number:21 CFR 870.3600
Product Code:DTE
Classification:Class III
Classification Panel:Cardiovascular
Special Controls:Not applicable
Predicate Devices:Medtronic Model 5392 External Pulse Generator (EPG) K13292-

4

Device Description

The Model 5392 EPG is a battery-powered, dual chamber, temporary pacemaker designed primarily for temporary antibradycardia pacing therapy. The 53922 EPG cover accessory is an optional disposable protective cover to reduce accidental activation of the controls of the 5392 EPG.

Indications for Use

The temporary pacemaker is used with a cardiac pacing lead system for temporary single or dual chamber pacing in a clinical environment by trained personnel. The temporary pacemaker can be used where short-term demand (synchronous) or asynchronous pacing is indicated for therapeutic, prophylactic or diagnostic purposes. The temporary pacemaker must be used in an environment where the patient is monitored continuously to ensure that it is operating properly and delivering appropriate therapy to the patient.

Specific indications for temporary cardiac pacing include, but are not limited to, the following:

  • . Complete heart block
  • o Sinus bradycardia
  • Sick sinus syndrome ●
  • Bradycardia with congestive heart failure ●
  • Atrial and/or ventricular arrhythmias
  • Cardiac arrest ●
  • Support, management, and evaluation of a patient prior to permanent pacemaker Implantation
  • Support during permanent pacemaker replacement ●
  • Cardiac complications during invasive or surgical procedures ●
  • o Support following cardiac surgery
  • Acute myocardial infarction complicated by heart block ●
  • Atrial tachyarrhythmias that require high-rate burst pacing for treatment ●

Technological Characteristics

Intended use, design, materials, performance and technological characteristics are substantially equivalent to the predicate devices referenced.

Technological Characteristics

When compared to the predicate device (K132924), the modified Medtronic Model 5392 External Pulse Generator presented in this submission has the same:

  • Intended use/indications for use ●
  • Operating principle ●
  • Design features ●

5

  • Device functionality ●
  • o Biological safety
  • Packaging materials
  • Shelf life ●

The modified Model 5392 EPG and the predicate device differ in the following:

  • Modified negative battery contact design ●

Substantial Equivalence and Summary of Studies:

Technological differences between the subject and predicate devices have been evaluated through bench tests to provide evidence of safe and effective use. The modified Medtronic Model 5392 External Pulse Generator is substantially equivalent to the specified predicate device based on comparisons of the device functionality, technological characteristics, and indications for use. The device design and materials have been verified through the following:

  • Regression bench testing to product level performance requirements ●

Conclusion:

The results of the above verification tests met the specified acceptance criteria and did not raise new safety or performance issues. Therefore, the modifications made to the Medtronic Model 5392 External Pulse Generator described in this submission result in a device that is substantially equivalent to the predicate.