(28 days)
- Assessment of symptoms that may be related to Rhythm Disturbances of the Heart in patients from pediatric to adult age. Patients with palpitations.
- Assessment of risk in Patients With or Without Symptoms of Arrhythmia. Patients with symptomatic or asymptomatic idiopathic hypertrophic cardiomyopathy and postmyocardial infarction patient with left ventricular dysfunction using arrhythmia e.g .: ventricular ectopy, as method of risk assessment.
- Assessment of Efficacy of Antiarrhythmic Therapy. Patients with baseline high frequency, reproducible, sustained, symptomatic premature ventricular complexes supraventricular arrhythmia or ventricular tachycardia.
- Assessment of Pacemaker Function. Evaluation of patients with paroxysmal symptoms, detection of myopotential inhibition, detection of pacemaker mediated tachycardia, evaluation of antitachycardia pacing device function, evaluation of rate-responsive physiological pacing function.
- Detection of Myocardial Ischemia. Paticnts with chest pain suggestive of Prinzmetal's angina.
The Holter 2000-Software is a device that when installed onto a user's Hardware platform, will convert their system into a Holter scanner analyzes recorded cardiac ECG and creates reports from the recorded data. The patient's ECG is pre-recorded onto one of several data storage mediums, which is fed into user's Holter system whereby the Holter 2000 software analyzes the ECG and provides reports on a variety of cardiac data. The cardiac data that is analyzed is individual ECG waveforms and patterns of consecutive waveforms. Cardiac data provided by Zymed's Holter 2000-Software is used by trained medical personnel to diagnosis patients with various cardiac rhythm patterns. The Zymed software system presents the user with a number of clinical tools such as ECG report generation. The system also provides tools to review a patient's cardiac performance. Features such as individual ECG printouts, multi-channel automatic ST analysis, multi-channel morphology analysis and Custom Reports further enhance the system's qualities as a valuable and practical clinical tool. The system has the options available: Full Arrhythmia analysis to include multi-channel automatic ST Analysis 12 lead ECGD Data Acquisition on 2 or 3 Channels Digital Input
Here's an analysis of the provided text regarding the acceptance criteria and study for the Zymed Holter 2000 - Software:
Please note that this document is a 510(k) summary for substantial equivalence, not a detailed clinical study report. Therefore, some information, particularly regarding specific statistical thresholds for acceptance criteria and the full rigor of a standalone study, might not be explicitly stated or as granular as one would find in a peer-reviewed publication.
1. Table of Acceptance Criteria and Reported Device Performance
The document doesn't explicitly state numerical acceptance criteria in the traditional sense (e.g., "sensitivity must be > 90%"). Instead, it states that "Performance was measured against industry accepted AHA (AHA), MIT (MIT) and European ST-T (EST) databases. Results were typical for the Holter as targeted. Separate sensitivities (SE), positive predictivity (+P), and false positive rate (FPR) were examined for each database and measured for QRS. Ventricular. Couplets, Short runs and Long runs. Separate Episode Sensitivities (ESE), Episode Positive Predictivity (E+P), Duration Sensitivity (DSE) and Duration Positive Predictivity (D+P) were examined for the European ST-T (EST) database and measured for ST analysis."
The key "acceptance criterion" implied is substantial equivalence to the predicate device, demonstrated by "nearly identical data" for performance.
| Criterion Type | Specific Metric (for QRS, Ventricular, Couplets, Short/Long runs) | Reported Device Performance (Holter 2000-Software) |
|---|---|---|
| Arrhythmia Analysis | Sensitivity (SE) | "Typical for the Holter as targeted" |
| Positive Predictivity (+P) | "Typical for the Holter as targeted" | |
| False Positive Rate (FPR) | "Typical for the Holter as targeted" | |
| ST Analysis | Episode Sensitivity (ESE) | "Typical for the Holter as targeted" |
| (from EST database) | Episode Positive Predictivity (E+P) | "Typical for the Holter as targeted" |
| Duration Sensitivity (DSE) | "Typical for the Holter as targeted" | |
| Duration Positive Predictivity (D+P) | "Typical for the Holter as targeted" | |
| High Heart Rates | Performance at > 300 bpm (e.g., pediatric patients) | Demonstrated "within recommended guidelines" |
| Noise Resilience | Performance in presence of baseline, electrode, or muscle noise | "Equivalent to the old system" |
| Overall Comparison | Data comparison with predicate device | "Nearly identical data" |
2. Sample Size Used for the Test Set and Data Provenance
- Sample Size: Not explicitly stated. The document refers to "industry accepted AHA (AHA), MIT (MIT) and European ST-T (EST) databases." These are known public databases of ECG recordings, but the exact number of cases or recordings utilized for this specific submission is not provided.
- Data Provenance: The databases mentioned (AHA, MIT, EST) are public, widely recognized, and generally well-documented academic/clinical databases. These are typically retrospective collections of patient ECG data. The specific country of origin for each database's full content is varied, but they are international standards.
3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications
This information is not provided in the document. For industry-accepted databases like AHA, MIT, and EST, the ground truth (annotations) is meticulously established, often by multiple experienced cardiologists or electrophysiologists, following established guidelines. However, the specific process for this submission's use of those databases is not detailed.
4. Adjudication Method for the Test Set
This information is not provided. Given that the ground truth comes from established databases, the adjudication method for their original annotation would have been part of the database creation process. For the purpose of this submission, the device's output was simply compared against the already established ground truth in these databases.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done
No, an MRMC comparative effectiveness study was not done as described in this document. The study focuses solely on the performance of the algorithm (the Zymed Holter 2000-Software) against established ECG databases and a comparison to its predicate device. There is no mention of human readers or AI assistance for human readers.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done
Yes, a standalone study was done. The performance evaluation described is entirely focused on the Zymed Holter 2000-Software's ability to analyze ECG data and generate reports automatically. It measures the algorithm's performance (sensitivities, predictivities, FPR) against the ground truth of the databases. The "Software Trade Name: Holter 2000 - Software" indicates it's an algorithm-driven system for analysis.
7. The Type of Ground Truth Used
The ground truth used was expertly-annotated ECG data from established and industry-accepted databases (AHA, MIT, EST). These databases contain recordings where cardiac events (e.g., QRS complexes, ventricular events, ST changes) have been manually identified and labeled by human experts.
8. The Sample Size for the Training Set
The sample size for the training set is not provided. The document describes a comparison against recognized databases for testing. Information about how the algorithm was trained, including the dataset size, is not included in this 510(k) summary.
9. How the Ground Truth for the Training Set Was Established
This information is not provided. As with the training set size, the specifics of the algorithm's development and the ground truth used for its training are outside the scope of this 510(k) summary, which focuses on demonstrating substantial equivalence through testing.
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JUL 28 1999
7 ymed
Zemed Inc. 9) North Aviador Street Camarillo, California 93063.838 800 .. 35.50 .! - 805.98 - gol 1.11 8015.95-115 3.
510(k) Summary
Submitter:
Gretel Lumley, Quality Assurance Engineer Zymed Medical Instrumentation 20 North Aviador Street Camarillo, CA 93010 805-987-9532 Fax: Phone: 800-235-5941 (417) 6-29-99 Date of Summary: G. Lumley - see above Contact:
Zymed Holter 2000 - Software Trade Name: Holter Analyzer Common Name: Electrocardiograph, Ambulatory, with Analysis Algorithm Classification Name: (per 21 CFR 870.2800)
Legally marketed device to which S.E. is claimed. Holter 2000 - 510(k) 990170
Description: The Holter 2000-Software is a device that when installed onto a user's Hardware platform, will convert their system into a Holter scanner analyzes recorded cardiac ECG and creates reports from the recorded data. The patient's ECG is pre-recorded onto one of several data storage mediums, which is fed into user's Holter system whereby the Holter 2000 software analyzes the ECG and provides reports on a variety of cardiac data. The cardiac data that is analyzed is individual ECG waveforms and patterns of consecutive waveforms. Cardiac data provided by Zymed's Holter 2000-Software is used by trained medical personnel to diagnosis patients with various cardiac rhythm patterns.
The Zymed software system presents the user with a number of clinical tools such as ECG report generation. The system also provides tools to review a patient's cardiac performance. Features such as individual ECG printouts, multi-channel automatic ST analysis, multi-channel morphology analysis and Custom Reports further enhance the system's qualities as a valuable and practical clinical tool.
The system has the options available: Full Arrhythmia analysis to include multi-channel automatic ST Analysis 12 lead ECGD Data Acquisition on 2 or 3 Channels Digital Input
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Indications for Use:
-
- Assessment of symptoms that may be related to Rhythm Disturbances of the Heart in patients from pediatric to adult age. Patients with palpitations.
-
- Assessment of risk in Patients With or Without Symptoms of Arrhythmia. Patients with symptomatic or asymptomatic idiopathic hypertrophic cardiomyopathy and postmyocardial infarction patient with left ventricular dysfunction using arrhythmia e.g .: ventricular ectopy, as method of risk assessment.
-
- Assessment of Efficacy of Antiarrhythmic Therapy. Patients with baseline high frequency, reproducible, sustained, symptomatic premature ventricular complexes supraventricular arrhythmia or ventricular tachycardia.
-
- Assessment of Pacemaker Function. Evaluation of patients with paroxysmal symptoms, detection of myopotential inhibition, detection of pacemaker mediated tachycardia, evaluation of antitachycardia pacing device function, evaluation of rate-responsive physiological pacing function.
-
- Detection of Myocardial Ischemia. Paticnts with chest pain suggestive of Prinzmetal's angina.
Review of Technology characteristics compared to the predicate device:
| Platform | Holter 2000 (Predicate) | Holter 2000-Software |
|---|---|---|
| Holter | Holter | |
| Type | IBM PC AT Compatible | Same |
| CPU | 200 Mhz Pentium Pro or greater | Same |
| RAM | 64 M Bytes Minimum | Same |
| Hard Disk | 540 M Bytes Minimum | Same |
| Display | SVGA | Same |
| Data Acquisition | ||
| Number of Channels | 2 or 3 | Same |
| Resolution | 8 bits | Same |
| Sampling Frequency | 192 samples per second | Same |
| Digital Input | Yes | Same |
| Software | ||
| Operating System | Windows NT | Same |
| ST Segment Analysis | Yes | Same |
| Hardware Suppliedby User to published minimumspecification. |
The only difference between the two Zymed systems is that one system is supplied as a complete system while the other is a software only package.
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Performance was measured against industry accepted AHA (AHA), MIT (MIT) and European ST-T (EST) databases. Results were typical for the Holter as targeted. Separate sensitivities (SE), positive predictivity (+P), and false positive rate (FPR) were examined for each database and measured for ORS. Ventricular. Couplets, Short runs and Long runs. Separate Episode Sensitivities (ESE), Episode Positive Predictivity (E+P), Duration Sensitivity (DSE) and Duration Positive Predictivity (D+P) were examined for the European ST-T (EST) database and measured for ST analysis. High heart rates to include pediatric patients were demonstrated to be within recommended guidelines in excess of 300 bpm, and performance in the presence of noise indicates the new system is equivalent to the old system when looking at baseline, electrode or muscle as the cause of noise.
In summary, performance data between the two systems shows nearly identical data, and therefore, supports a claim of Substantial Equivalence.
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Image /page/3/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three lines that resemble an abstract human figure.
Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850
JUL 28 1999
Ms. Gretel Lumley Quality Assurance Engineer Zymed, Inc. 20 North Aviador Street Camarillo, CA 93010-8302
Re: K992197 Modification to Zymed Holter 2000 Requlatory Class: II (two) Product Code: MLO Dated: June 29, 1999 Received: June 30, 1999
Dear Ms. Lumley:
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 Requlations, Title 21, Parts 800 A substantially equivalent determination assumes compliance to 895. with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Requlation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Druq 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
{4}------------------------------------------------
concerning your device in the Federal Register. Please note: this 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 predicate 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 diaqnostic devices), please contact the Office of Compliance at (301) 594-4648. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, 2Misbranding by reference to premarket notification² (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,
Thomas J. Callahan, Ph.D.
Director Division of Cardiovascular, Respiratory, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
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K9921977 510(k) Number:
Device Name: Zymed Holter 2000
Indications for Use:
- Assessment of symptoms that may be related to rhythm disturbances of the heart in patients . from pediatric to adult age. Patients with palpitations.
- Assessment of risk in Patients With or Without Symptoms of Arrhythmia. Patients with . symptomatic or asymptomatic idiopathic hypertrophic cardiomyopathy and postmyocardial infarction patient with left ventricular dysfunction using arrhythmia e.g .: ventricular ectopy, as method of risk assessment.
- Assessment of efficacy of Antiarrhythmia Therapy. Patients with baseline high frequency, . reproducible, sustained, symptomatic premature ventricular complexes supraventricular arrhythmia or ventricular tachycardia.
- Assessment of Pacemaker Function. Evaluation of patients with paroxysmal symptoms, . detection of myopotential inhibition, detection of pacemaker mediated tachycardia, evaluation of antitachycardia pacing device function, evaluation of rate-responsive physiological pacing function.
- Detection of Myocardial Ischemia. Patients with chest pain suggestive of Prinzmetal's . angina.
(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)
Q.K. Miller
(Division Sign-Off)
of Cardiovascular, Respiratory,
Prescription Use
(CFR21 CFR 801.109)
Or
Over-The-Counter Use
§ 870.2800 Medical magnetic tape recorder.
(a)
Identification. A medical magnetic tape recorder is a device used to record and play back signals from, for example, physiological amplifiers, signal conditioners, or computers.(b)
Classification. Class II (performance standards).