MAUDE Adverse Event Report: ST. JUDE MEDICAL, INC. BRK? TRANSSEPTAL NEEDLE, 71 CM LENGTH

Model Number 407200

Device Problem Unexpected Therapeutic Results (1631)

Patient Problems Low Blood Pressure/ Hypotension (1914); Pericardial Effusion (3271)

Event Date 12/04/2014

Event Type  Injury  

Event Description

Related manufacturer reference 3005334318-2014-00014, 3005188751-2014-00153, 3005188751-2014-00155.Following an atrial fibrillation ablation procedure performed on a patient with complicated cardiac anatomy, a pericardial effusion occurred.After the ablation procedure was completed, the patient became hypotensive and an echocardiogram revealed a pericardial effusion originating from the left atrium.A pericardiocentesis was performed, which stabilized the patient, and no further intervention was required.There were no performance issues with any sjm device.

Manufacturer Narrative

The results of the investigation are inconclusive since the device was not returned for analysis.A review of the device history record was not possible since the batch number was unavailable.Based on the information received, the cause of the reported incident could not be conclusively determined.Per the ifu, cardiac perforation is a known risk during the use of this device.

• Brand Name: BRK? TRANSSEPTAL NEEDLE, 71 CM LENGTH
• Type of Device: TRANSSEPTAL NEEDLE
• Manufacturer (Section D): ST. JUDE MEDICAL, INC.; 14901 deveau place; minnetonka MN 55345
• Manufacturer (Section G): ST. JUDE MEDICAL, INC. (AF-MINNETONKA); 14901 deveau place; minnetonka MN 55345
• Manufacturer Contact: denise johnson ; 5050 nathan lane north; plymouth, MN 55442 ; 6517564470
• MDR Report Key: 4366923
• MDR Text Key: 21237851
• Report Number: 3005188751-2014-00154
• Device Sequence Number: 1
• Product Code: DRC
• Combination Product (y/n): N
• Reporter Country Code: SP
• PMA/PMN Number: K072278
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 12/04/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 407200
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 12/04/2014
• Initial Date FDA Received: 12/29/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: AGILIS NXT INTRODUCER; SWARTZ BRAIDED TRANSSEPTAL INTRODUCER; NON-SJM CATHETER; TACTICATH QUARTZ ABLATION CATHETER
• Patient Outcome(s): Required Intervention
• Patient Age: 63 YR
• Patient Weight: 117