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The Zio AT device is intended to capture and transmit symptomatic and asymptomatic cardiac events and record continuous electrocardiogram (ECG) data for long-term monitoring. It is indicated for use on patients 18 years or older who may be asymptomatic or who may suffer from transient symptoms such as palpitations, shortness of breath, dizziness, light-headedness, pre-syncope, syncope, fatigue, or anxiety. It is not intended for use on critical care patients.

The Zio AT® Electrocardiogram (ECG) Monitoring System is intended for continuous, long-term monitoring of a patient's ECG data with the ability to provide symptomatic and asymptomatic transmissions of potential arrhythmias during wear time. The Zio AT ECG Monitoring System enables ambulatory Mobile Cardiac Telemetry (MCT) services for non-critical care patients by providing the following devices for use. The Zio AT device consists of the Zio AT patch and Zio AT wireless gateway. The Zio AT patch is a single-use ECG monitor applied to the patient's chest, in-clinic or at home, and worn for up to 14 days without any required patient interaction for maintenance, such as replacing or charging a battery. The patch continuously records ECG data and transmits symptomatic and asymptomatic cardiac events through the Zio AT wireless gateway during the wear period. After the wear period concludes, the patient removes and returns the patch to the monitoring center, an Independent Diagnostic Testing Facility (IDTF), for analysis and end-of-wear reporting. The Zio AT wireless gateway securely receives ECG data from the Zio AT patch using Bluetooth technology. The gateway securely transmits ECG data through cellular technology for subsequent processing.

The provided document, a 510(k) Summary for the Zio AT® device (K240029), states that no clinical testing was performed in support of this premarket notification. The submission relies solely on nonclinical testing to demonstrate substantial equivalence to the predicate device (Zio® AT ECG Monitoring Device [K163512]).

Therefore, based on the provided text, I cannot provide details regarding acceptance criteria, reported device performance, sample sizes for test sets, data provenance, expert ground truth establishment, adjudication methods, MRMC studies, or standalone performance that would typically be associated with clinical studies.

The document indicates that the device's acceptance criteria were based on its conformance to established performance specifications and FDA-recognized consensus standards. The study that proves the device meets these acceptance criteria is the nonclinical testing described.

Here's an overview of the information available:

1. A table of acceptance criteria and the reported device performance

The document does not provide a specific table of quantitative acceptance criteria and reported device performance metrics in the format typically seen with clinical study results (e.g., sensitivity, specificity, accuracy for arrhythmia detection). Instead, it states that "All necessary performance testing was conducted on the Zio AT device to ensure performance as intended per specifications and to support a determination of substantial equivalence to the predicate device."

The acceptance criteria implicitly relate to the successful completion of the following nonclinical tests and their conformance to specified standards:

• System performance testing: This would ensure the device functions as designed in various operational aspects.
• Biocompatibility testing: This confirms the materials used in the device are safe for contact with the human body.
• Firmware verification testing: This validates the software operating the device.
• Electrical safety and EMC testing: This ensures the device is electrically safe and does not interfere with other electronic devices, and vice versa.

The reported device performance, in this context, is that the device "meets the requirements of established conformance standards and performance specifications necessary for its intended use."

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

Not applicable, as no clinical testing was performed. The nonclinical testing would use various test samples and equipment as dictated by the specific standards and internal protocols, but these are not disclosed in terms of number or provenance in the provided summary.

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)

Not applicable, as no clinical testing with expert ground truth establishment was performed.

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

Not applicable, as no clinical testing requiring adjudication was performed.

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

Not applicable, as no clinical testing or MRMC study was performed. The Zio AT device itself functions as a monitoring and transmission system, not an AI-powered diagnostic aid that assists human readers in real-time interpretation.

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

The device is described as "intended to capture and transmit symptomatic and asymptomatic cardiac events and record continuous electrocardiogram (ECG) data." While it transmits events, the overall system for diagnosis involves a monitoring center for analysis and end-of-wear reporting, which would typically involve human oversight. The provided text does not suggest a standalone algorithm-only diagnostic performance evaluation in a clinical setting. The nonclinical testing focused on the device's functional performance and compliance with relevant standards.

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

Not applicable, as no clinical testing that would require such ground truth for diagnostic accuracy was performed. For nonclinical tests, the "ground truth" would be the specified parameters and expected outputs defined by the relevant engineering and safety standards.

8. The sample size for the training set

Not applicable, as no clinical testing or development of an AI algorithm based clinical data was detailed as part of this submission for demonstrating substantial equivalence. The device is an updated version of a previously cleared device, focusing on hardware and firmware changes.

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

Not applicable for the same reasons as #8.

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