K Number
K220362
Device Name
LE-12CH
Date Cleared
2022-03-25

(45 days)

Product Code
Regulation Number
870.2340
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The intended use of LE-12CH electrocardiograph is to acquire ECG signals from adult and pediatric patients (beginning at birth through 21 vears of age) through body surface FCG electrocardiograph is only intended to be used in hospitals or healthcare facilities by doctors and trained healtheare professionals. The cardiogram recorded by the electrocardiograph can help users to analyze and diagnose heart disease. However, the interpreted ECG with measurements and interpretive statements is offered to clinicians on an advisory basis only.
Device Description
CAF Medical's LE-12CH electrocardiograph device is a twelve-channel electrocardiograph, which features a user-friendly design, a high-resolution 8.4-inch (800*600) TFT LCD touch screen, an alphanumeric keypad and an optimized workflow. The LE-12CH electrocardiograph can acquire 12-channel waveforms simultaneously, and can also print the 12-channel electrocardiograph waveforms simultaneously, using a 216 mm wide thermal printer. An advanced digital filtering technique has been used in the LE-12CH device, including a baseline anti-drift filter, AC noise filter (50/60 Hz), EMG filter and low-pass filter, which can help the user record the ECG more clearly. The LE-12CH electrocardiograph works by sampling the ECG signal from the patient's skin surface using special electrodes. This signal is then amplified and sampled in A/D format by the ECG board. The ECG board transfers the data to the system's MCU via UART. The MCU filters the data, sends it to the LCD, prints the waveforms on paper and stores the data in memory. This log can be stored in flash memory or sent to the PC via Ethernet, WIFI or RS232. During the examination, no substances are given to or removed from the patient. The LE-12CH electrocardiograph supports cardiac stress testing.
More Information

Not Found

No
The description mentions "advanced digital filtering technique" and "interpreted ECG with measurements and interpretive statements is offered to clinicians on an advisory basis only," but does not explicitly mention AI or ML, nor does it describe any training or test sets typically associated with such technologies. The filtering and interpretation appear to be based on traditional signal processing and pre-programmed algorithms.

No
The device is an electrocardiograph used to acquire and analyze ECG signals for diagnosis, not to provide therapy.

Yes
The device is described as an electrocardiograph whose recorded cardiogram "can help users to analyze and diagnose heart disease." This directly indicates its role in providing information for diagnostic purposes.

No

The device description explicitly details hardware components such as a touch screen, keypad, thermal printer, ECG board, MCU, and various physical interfaces (Ethernet, WIFI, RS232). It describes the physical process of acquiring and processing ECG signals using these hardware elements.

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

Here's why:

  • IVDs analyze samples taken from the body. The description clearly states that the LE-12CH electrocardiograph acquires ECG signals from the patient's body surface using electrodes. It does not involve the analysis of blood, urine, tissue, or any other sample removed from the patient.
  • The device measures electrical activity. Electrocardiographs measure the electrical activity of the heart. This is a physiological measurement taken directly from the patient, not an analysis of a biological sample.
  • The intended use is for acquiring and analyzing ECG signals. The purpose is to help users analyze and diagnose heart disease based on these electrical signals.

Therefore, the LE-12CH electrocardiograph falls under the category of a medical device that performs a physiological measurement, not an IVD.

N/A

Intended Use / Indications for Use

The intended use of LE-12CH electrocardiograph is to acquire ECG signals from adult and pediatric patients (beginning at birth through 21 years of age) through body surface FCG electrocardiograph is only intended to be used in hospitals or healthcare facilities by doctors and trained healtheare professionals. The cardiogram recorded by the electrocardiograph can help users to analyze and diagnose heart disease. However, the interpreted ECG with measurements and interpretive statements is offered to clinicians on an advisory basis only.

Product codes

DPS

Device Description

CAF Medical's LE-12CH electrocardiograph device is a twelve-channel electrocardiograph, which features a user-friendly design, a high-resolution 8.4-inch (800*600) TFT LCD touch screen, an alphanumeric keypad and an optimized workflow.

The LE-12CH electrocardiograph can acquire 12-channel waveforms simultaneously, and can also print the 12-channel electrocardiograph waveforms simultaneously, using a 216 mm wide thermal printer.

An advanced digital filtering technique has been used in the LE-12CH device, including a baseline anti-drift filter, AC noise filter (50/60 Hz), EMG filter and low-pass filter, which can help the user record the ECG more clearly.

The LE-12CH electrocardiograph works by sampling the ECG signal from the patient's skin surface using special electrodes. This signal is then amplified and sampled in A/D format by the ECG board. The ECG board transfers the data to the system's MCU via UART. The MCU filters the data, sends it to the LCD, prints the waveforms on paper and stores the data in memory. This log can be stored in flash memory or sent to the PC via Ethernet, WIFI or RS232. During the examination, no substances are given to or removed from the patient. The LE-12CH electrocardiograph supports cardiac stress testing.

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

adult and pediatric patients (beginning at birth through 21 years of age)

Intended User / Care Setting

hospitals or healthcare facilities by doctors and trained healthcare professionals.

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 LE-12CH was tested to evaluate its performance based on the following standards:
IEC 60601-1 ((2005) + Amd. 1 (2012))
IEC 60601-1-2 (Edition 4.0 2014)
IEC 60601-2-25 (Edition 2.0 2011)

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

Not Found

Predicate Device(s)

K171942, Edan Instruments, Inc.

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2340 Electrocardiograph.

(a)
Identification. An electrocardiograph is a device used to process the electrical signal transmitted through two or more electrocardiograph electrodes and to produce a visual display of the electrical signal produced by the heart.(b)
Classification. Class II (performance standards).

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March 25, 2022

CAF Medical Solutions Inc. % Juan Tezak Consultant Compliance 4 Devices 118 W Prive Cr. Delray Beach, Florida 33445

Re: K220362

Trade/Device Name: LE-12CH Regulation Number: 21 CFR 870.2340 Regulation Name: Electrocardiograph Regulatory Class: Class II Product Code: DPS Dated: February 8, 2022 Received: February 8, 2022

Dear Juan Tezak:

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.

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

1

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 (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Jennifer Shih Assistant Director Division of Cardiac Electrophysiology, Diagnostics and Monitoring Devices Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use Statement

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Exp
See

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2023 See PRA Statement below.

Indications for UseSee PRA Statement below.
510(k) Number (if known)
K220362
Device Name
LE-12CH
Indications for Use (Describe)
Type of Use (Select one or both, as applicable)The intended use of LE-12CH electrocardiograph is to acquire ECG signals from adult and pediatric patients (beginning at
birth through 21 vears of age) through body surface FCG electrocardiograph is only intended to be used in
hospitals or healthcare facilities by doctors and trained healtheare professionals. The cardiogram recorded by the
electrocardiograph can help users to analyze and diagnose heart disease. However, the interpreted ECG with
measurements and interpretive statements is offered to clinicians on an advisory basis only.
> Prescription Use (Part 21 CFR 801 Subpart D)Over-The-Counter Use (21 CFR 801 Subpart C)
CONTINUE ON A SEPARATE PAGE IF NEEDED.
This section applies only to requirements of the Paperwork Reduction Act of 1995.
DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW!
The burden time for this collection of information is estimated to average 79 hours per response, including the
time to review instructions, search existing data sources, gather and maintain the data needed and complete
and review the collection of information. Send comments regarding this burden estimate or any other aspect
of this information collection, including suggestions for reducing this burden, to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
PRAStaff(@fda.hhs.gov
"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB number."
FORM FDA 3881 (6/20)Page 1 of 1PSC Publishing Services (301) 443-6740

PSC Publishing Services (S

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510(k) Summary

LE-12CH February, 2022

ADMINISTRATIVE INFORMATION

Applicant

CAF Medical Solutions Inc. 17539 Roberts Road, Hockley TX 77477 USA E-mail: c.ortiz@cafmedical.com Phone: +1 713 614 7049

Establishment Registration Number

Official Contact

Oscar Arriaga Yamin Legal Representative 17539 Roberts Road, Hockley TX 77477 USA Phone: +1 713 614 7049 E-mail: c.ortiz@cafmedical.com

Representative/Consultant

Juan Tezak Carlos Marín Compliance4Devices 118 W Prive Cr. Delray Beach Fl, 33445 Phone: +1 561-789-2411 E-mail: compliance4devices@gmail.com

DEVICE AND CLASSIFICATION NAME

Device Trade Name:LE-12CH
Common Name:Electrocardiograph
Classification Regulation:21 CFR 870.2340
Classification Name:Electrocardiograph
Device Classification:Class II
Classification Panel:Cardiovascular
Product Code:DPS
Prior Submission:No Prior Submission

Predicate Device Information

Predicate Device:

K171942. Electrocardiograph with models SE-12, SE-12 Express, SE-1200 and SE-1200 Express. Edan Instruments, Inc.

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Intended Use / Indications for Use

The intended use of LE-12CH electrocardiograph is to acquire ECG signals from adult and pediatric patients (beginning at birth through 21 years of age) through body surface ECG electrodes. The electrocardiograph is only intended to be used in hospitals or healthcare facilities by doctors and trained healthcare professionals. The cardiogram recorded by the electrocardiograph can help users to analyze and diagnose heart disease. However, the interpreted ECG with measurements and interpretive statements is offered to clinicians on an advisory basis only.

Device Description

CAF Medical's LE-12CH electrocardiograph device is a twelve-channel electrocardiograph, which features a user-friendly design, a high-resolution 8.4-inch (800*600) TFT LCD touch screen, an alphanumeric keypad and an optimized workflow.

The LE-12CH electrocardiograph can acquire 12-channel waveforms simultaneously, and can also print the 12-channel electrocardiograph waveforms simultaneously, using a 216 mm wide thermal printer.

An advanced digital filtering technique has been used in the LE-12CH device, including a baseline anti-drift filter, AC noise filter (50/60 Hz), EMG filter and low-pass filter, which can help the user record the ECG more clearly.

The LE-12CH electrocardiograph works by sampling the ECG signal from the patient's skin surface using special electrodes. This signal is then amplified and sampled in A/D format by the ECG board. The ECG board transfers the data to the system's MCU via UART. The MCU filters the data, sends it to the LCD, prints the waveforms on paper and stores the data in memory. This log can be stored in flash memory or sent to the PC via Ethernet, WIFI or RS232. During the examination, no substances are given to or removed from the patient. The LE-12CH electrocardiograph supports cardiac stress testing.

Contraindications:

There are no known contraindications for use.

Equivalence to Marketed Device

LE-12CH is substantially equivalent to the predicate device. In further support of a substantial equivalence determination, here-under is a comparison chart with the subject device and predicate device.

Table 1. Comparison with predicate device for Summary

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ITEMPREDICATE DEVICEPROPOSED DEVICECOMPARISON
K#SE-1200 EXPRESS
K171942LE-12CH
K220362RESULT
Intended Use /
Indications for UseThe intended use of SE-12 series
electrocardiograph is to acquire ECG
signals from adult and pediatric
patient (beginning at birth through
21 years of age) through body
surface ECG
electrodes. The electrocardiograph is
only intended to be used in hospitals
or healthcare facilities by doctors and
trained healthcare professionals. The
cardiogram recorded by the
electrocardiograph can help users to
analyze and diagnose heart disease.
However, the interpreted ECG with
measurements and interpretive
statements is offered to clinicians on
an advisory basis
only.The intended use of LE-12CH
electrocardiograph is to acquire ECG
signals from adult and pediatric
patient (beginning at birth through
21 years of age) through body
surface ECG
electrodes. The electrocardiograph is
only intended to be used in hospitals
or healthcare facilities by doctors and
trained healthcare professionals. The
cardiogram recorded by the
electrocardiograph can help users to
analyze and diagnose heart disease.
However, the interpreted ECG with
measurements and interpretive
statements is offered to clinicians on
an advisory basis
only.Same
Safety Specifications
Safety StandardsIEC 60601-1:2005/A1:2012 EN 60601-
1:2006/A1:2013 IEC 60601-1-2:2007
EN 60601-1-2:2007/AC:2010 IEC/EN
60601-2-25IEC 60601-1 ((2005) + Amd. 1 (2012))
IEC 60601-1-2 (Edition 4.0 2014)
IEC 60601-2-25 (Edition 2.0 2011)Same
Anti-electric-shock
type:Class I with internal power
supplyClass I with internal power
supplySame
Anti-electric-shock
degree:Type CFType CFSame
Degree of protection
against harmful
ingress of
water:Ordinary equipment (Sealed
equipment without liquid proof)Ordinary equipment (Sealed
equipment without liquid proof)Same
Disinfection/sterilizati
on method:Refer to the user manual for
detailsRefer to the user manual for
detailsSame
Degree of safety of
application in the
presence of
flammable gas:Equipment not suitable for use in the
presence of flammable gasEquipment not suitable for use in the
presence of flammable gasSame
Working mode:Continuous operationContinuous operationSame
EMC:CISPR 11 Group 1, Class ACISPR 11 Group 1, Class ASame
Ingress ratingIPX0IPX0Same
Environment Specifications
Temperature
Transport &
Storage-20ºC (-4ºF) ~ +55ºC (+131ºF)-20ºC (-4ºF) ~ +55ºC (+131ºF)Same
Working+5ºC (+41ºF) ~ +40ºC (+104ºF)+5ºC (+41ºF) ~ +40ºC (+104ºF)Same
Relative Humidity:
Transport & Storage25%~93%
Non-Condensing25%~93%
Non-CondensingSame
ITEMPREDICATE DEVICE
SE-1200 EXPRESSPROPOSED DEVICE
LE-12CHCOMPARISON
RESULT
Working25% RH ~ 80% RH
Non-Condensing25% RH ~ 80% RH
Non-CondensingSame
Atmospheric Pressure:
Transport &
Storage700 hPa ~1060 hPa700 hPa ~1060 hPa
Working860 hPa ~1060 hPa860 hPa ~1060 hPaSame
Power Supply Specifications
Mains Supply:Operating Voltage =100V-240V~Operating Voltage =100V-240V~
Operating frequency = 50 Hz / 60 HzOperating frequency = 50 Hz / 60 Hz
Input Current = 0.9-0.4A
Or Input power = 96VAInput Current = 0.9-0.4A
Or Input power = 96VA
Built-in LithiumRated voltage = 14.8 VRated voltage = 14.8 VSame
Battery Pack:SE-12 Express&SE-1200 Express:
Rated capacity = 5000mAh
SE-12& SE-1200: Rated capacity =
2500mAhRated capacity = 5000mAhSame
When the battery is fully charged, SE-
12& SE-1200can work normally
about4hours, and it can continually
print about 1.5 hours in the manual
mode or print about300 ECG reports
of 3×4+1Rin the auto mode; SE-12
Express& SE-1200 Express can work
normally about 5 hours, and it can
continually print about 2.5 hours in
the manual mode or print about 350
ECG reports of 3×4+1Rin the auto
mode.When the battery is fully charged, L-
12 CH can work normally about 5
hours, and it can continually print
about 2.5 hours in the manual mode
or print about 350 ECG reports of
3×4+1Rin the auto mode.
Performance Specifications
Recording
Recorder:Thermal dot-matrix recorderThermal dot-matrix recorder
Printing Density8 dots per mm / 200 dots per inch
(amplitude axes)
40 dots per mm / 1000 dots per inch
(time axes, @25mm/s)8 dots per mm / 200 dots per inch
(amplitude axes)
40 dots per mm / 1000 dots per inch
(time axes, @25mm/s)Same
Recorder Paper:Folded thermal paper:
210mm×295mm×100pages Folded
thermal paper:
215mm×280mm×100pages
(Optional)
Rolled thermal paper: 210mm×30m
(Optional)Folded thermal paper:
210mm×295mm×100pages Folded
thermal paper:
215mm×280mm×100pages
(Optional)
Rolled thermal paper: 210mm×30m
(Optional)Same
Effective Width:210mm210mmSame
Paper Speed:5mm/s, 6.25mm/s, 10mm/s,
12.5mm/s, 25mm/s, 50mm/s
(±3%)5mm/s, 6.25mm/s, 10mm/s,
12.5mm/s, 25mm/s, 50mm/s
(±3%)Same
Accuracy of data:±5% (x-axis), ±5%(y-axis)±5% (x-axis), ±5%(y-axis)Same
ITEMPREDICATE DEVICE
SE-1200 EXPRESSPROPOSED DEVICE
LE-12CHCOMPARISON
RESULT
HR Recognition
Technique:Peak-Peak DetectionPeak-Peak DetectionSame
HR Range:30 BPM ~ 300 BPM30 BPM ~ 300 BPMSame
Accuracy:±1 BPM±1 BPMSame
Leads:Standard 12 leadsStandard 12 leadsSame
Acquisition
Mode:Simultaneously 12 leadsSimultaneously 12 leadsSame
A/D24 bits24 bitsSame
Resolution:2.52uV/LSB2.52uV/LSBSame
Time Constant:≥ 3.2 s≥ 3.2 sSame
Frequency
Response:0.01Hz ~ 300 Hz (-3 dB)0.01Hz ~ 300 Hz (-3 dB)Same
Gain:1.25,2.5, 5, 10, 20, 10/5, AGC
(mm/mV)1.25,2.5, 5, 10, 20, 10/5, AGC
(mm/mV)Same
Input Impedance:≥100MΩ(10Hz)≥100MΩ(10Hz)Same
Input Circuit
Current:≤0.01μA≤0.01μASame
Input Voltage
Range≤±5 mVpp≤±5 mVppSame
Calibration
Voltage:1mV±2%1mV±2%Same
DC Offset
Voltage:±600 mV±600 mVSame
Noise:≤12.5 µVp-p≤12.5 µVp-pSame
Multi-channel
Crosstalk≤0.5 mm≤0.5 mmSame
FilterAC Filter: On / OffAC Filter: On / OffSame
EMG Filter: 25Hz / 35Hz / 45Hz
/ OFFEMG Filter: 25Hz / 35Hz / 45Hz
/ OFFSame
LOWPASS Filter:300Hz/ 270Hz/1
50Hz / 100Hz / 75HzLOWPASS Filter:300Hz/ 270Hz/1
50Hz / 100Hz / 75HzSame
CMRR≥140dB (AC ON)
≥123dB (AC OFF)≥140dB (AC ON)
≥123dB (AC OFF)Same
Sampling
Frequency16000Hz16000HzSame
Pacemaker Detection
Amplitude±750uVto ±700 mV±750uVto ±700 mVSame
Width50μs to 2.0 ms50μs to 2.0 msSame
Sampling Frequency16,000/sec/channel16,000/sec/channelSame
Input≥100 kΩ; Sensitivity 10 mm/V±5%;
Single ended≥100 kΩ; Sensitivity 10 mm/V±5%;
Single endedSame
Output≤100Ω; Sensitivity 1 V/mV ±5%;
Single ended≤100Ω; Sensitivity 1 V/mV ±5%;
Single endedSame
StandardTitle
BiocompatibilityISO 10993-1Biological Evaluation of Medical Device – Part 1: Evaluation and
Testing within a Risk Management Process
ISO 10993-5Biological Evaluation of Medical Device - Test for in vitro cytotoxicity
ISO 10993-10Biological Evaluation of Medical Device – Part 10: Test for irritation
and skin sensitization
EMCIEC 60601-1IEC Medical electrical equipment - Part 1: General requirements for
basic safety and essential performance
IEC 60601-1-2Medical electrical equipment - Part 1-2: General requirements for
basic safety and essential performance - Collateral Standard:
Electromagnetic disturbances - Requirements and tests
Bench TestingIEC 60601-2-25Medical electrical equipment - Part 2-25: Particular requirements
for the basic safety and essential performance of
electrocardiographs
Software ValidationGuidance for the Content of Premarket Submissions for Software
Contained in Medical Devices. Level of Concern "Moderate"

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Non-Clinical Testing Summary

The LE-12CH was tested to evaluate its performance based on the following standards:

Table 2. Standards compliance

Clinical Testing Summary

Clinical testing was not required to demonstrate the substantial equivalence of the subject device to the predicate device.

Conclusion

Based on the information presented in this 510(k) premarket notification, the LE-12CH is considered substantially equivalent (as safe, as effective and performs as well as) to the currently marketed device, K171942 Electrocardiograph SE-1200 Express, cited in this submission. Any differences noted between the LE-12CH and the predicate device do not impact safety or effectiveness based on the successfully conducted testing of the subject device.