Indications, safety, and warnings for SupraCross™ RF Transseptal Solution

INTENDED USE/INDICATIONS FOR USE

The SupraCross RF Wire is indicated for creation of an atrial septal defect in the heart.

CONTRAINDICATIONS

The SupraCross RF Wire is not recommended for use with any conditions that do not require the creation of an atrial septal defect. The Connector Cable is not recommended for use with any other generator or any other device.

WARNINGS

• Only physicians with a thorough understanding of angiography and percutaneous interventional procedures should use this device. It is recommended that physicians avail themselves of pre-clinical training, a review of pertinent literature and other appropriate education before attempting new interventional procedures.
• The SupraCross RF Wire and Connector Cable are supplied sterile using an ethylene oxide process. Do not use if the package is damaged. If damage is found, call your Boston Scientific representative.
• Laboratory staff and patients can undergo significant x-ray exposure during RF puncture procedures due to the continuous usage of fluoroscopic imaging. This exposure can result in acute radiation injury as well as increased risk for somatic and genetic effects. Therefore, adequate measures must be taken to minimize this exposure.
• The SupraCross RF Wire and Connector Cable are intended for single patient use only. Do not attempt to sterilize and reuse either devices. Reuse can cause patient injury and/or the transmission of infectious disease(s) from one patient to another. Reuse may result in patient complications.
• The SupraCross RF Wire must be used with the Connector Cable provided. Attempts to use it with other connector cables can result in electrocution of the patient and/or operator.
• Do not use the SupraCross RF Wire with electrocautery or electrosurgery generators, connector cables or accessories as attempted use can result in patient and/or operator injury.
• The Connector Cable must only be used with the RFP-100A RF Puncture Generator and the included SupraCross RF Wire. Attempts to use it with other generators and devices can result in electrocution of the patient and/or operator.
• The SupraCross RF Wire must be used with 0.035 in (0.89 mm) compatible transseptal sheath and/or dilator devices. Use of incompatible accessory devices may damage the integrity of the SupraCross RF Wire or accessory devices and may cause patient injury.
• The SupraCross RF Wire has only been validated for transseptal puncture use through SupraCross dilators which have been demonstrated to provide the required support for optimal function.
• The active tip and distal curve of the SupraCross RF Wire are fragile. Be careful not to damage the tip or the distal curve while handling the SupraCross RF Wire. If the tip or the distal curve becomes damaged at any time during its use, discard the SupraCross RF Wire immediately. Do not attempt to straighten the active tip if bent. Damage to device can lead to patient injury.
• The SupraCross RF Wire is not intended for use with neonatal patients (i.e. less than one month of age). Do not attempt to treat neonatal patients with the SupraCross RF Wire.
• Do not attempt to insert or retract the SupraCross RF Wire through a metal cannula or a percutaneous needle, which may damage the device and may cause patient injury.

PRECAUTIONS

• Do not attempt to use the SupraCross RF Wire and the Connector Cable before thoroughly reading the accompanying Instructions for Use.
• RF puncture procedures should be performed only by physicians thoroughly trained in the techniques of RF powered puncture in a fully equipped catheterization laboratory.
• The sterile packaging should be visually inspected prior to use. Do not use the devices if the packaging has been damaged or compromised.
• Visually inspect the SupraCross RF Wire and Connector Cable prior to use to ensure there are no cracks or damage to the insulating material. Do not use the wire or the cable if there is any damage.
• Do not use the SupraCross RF Wire and/or Connector Cable after the Use By date indicated on the label. 
• The SupraCross RF Wire and Connector Cable are intended for use with only those devices listed in the Additonal Required Items section.
• Read and follow the manufacturer’s Instructions For Use for the DIP electrode. Always use DIP electrodes that meet or exceed IEC 60601-2-2 requirements.
• Placement of the DIP electrode on the thigh could be associated with higher impedance. 
• In order to prevent the risk of ignition, ensure that flammable materials are not present in the room during RF power application.
• Take precautions to limit the effects that the electromagnetic interference (EMI) produced by the Generator may have on the performance of other equipment. Check the compatibility and safety of combinations of other physiological monitoring and electrical apparatus to be used on the patient in addition to the Generator.
• Adequate filtering must be used to allow continuous monitoring of the surface electrocardiogram (ECG) during RF power applications.
• Do not attempt to insert and use the proximal end of the SupraCross RF Wire as the active tip.
• Do not bend the SupraCross RF Wire or the Connector Cable. Excessive bending or kinking of the wire shaft, distal curve of the wire and/or the Connector Cable may damage the integrity of the device components and may cause patient injury. Care must be taken when handling the SupraCross RF Wire and Connector Cable.
• Careful manipulation of the SupraCross RF Wire must be performed to avoid vessel trauma. If resistance is encountered, do not use excessive force to advance or withdraw the SupraCross RF Wire or ancillary sheath and/or dilator assembly. Excessive force may lead to bending or kinking of the device limiting advancement and retraction of sheath and/or dilator device.
• SupraCross RF Wire and ancillary sheath and/or dilator assembly advancement should be done under imaging guidance. The use of visible markers on the wire body are only an approximate guide for positioning the wire tip with the distal end of the dilator.
• Do not attempt to deliver RF energy until the active tip of the SupraCross RF Wire is confirmed to be in good contact with the target tissue.
• Avoid RF energy delivery of the SupraCross RF Wire with incompatible dilator or cannula devices, which may lead to patient burns, ineffective puncture or failure to puncture.
• It is recommended not to exceed five (5) RF power applications per SupraCross RF Wire.
• Never disconnect the Connector Cable from the RFP-100A Radiofrequency Puncture Generator while radiofrequency puncture power is being delivered.
• Never disconnect the Connector Cable from the Generator by pulling on the cable. Failure to disconnect the cable properly may result in damage to the cable.
• Do not twist the Connector Cable while inserting or removing it from the Isolated Patient Connector on the Generator. Twisting the cable may result in damage to the pin connectors.
• The Generator is capable of delivering significant electrical power. Patient or operator injury can result from improper handling of the SupraCross RF Wire and/or DIP electrode, particularly when operating the device.
• During power delivery, the patient should not be allowed to come in contact with ground metal surfaces. 
• Apparent low power output or failure of the equipment to function properly at normal settings may indicate faulty application of the DIP electrode, failure to an electrical lead, or poor tissue contact at the active tip. Check for obvious equipment defects or misapplication. Attempt to better position the active tip of the SupraCross RF Wire against the atrial septum. Only increase the power if low power output persists.
• If using electroanatomical mapping guidance, it is recommended to use it along with alternative imaging modality in the event there is loss of visibility of the device.

ADVERSE EVENTS

Adverse events that may occur while using the SupraCross RF Wire include: 

• Allergic Reaction 
• Arrhythmias 
• Burn 
• Cardiac Arrest 
• Cardiac Tamponade 
• Cardiac Trauma 
• Cerebral Vascular Accident 
• Death
• Electric Shock 
• Embolism 
• Fistula 
• Heart Failure 
• Hematoma 
• Hemorrhage 
• Hypotension
• Infection 
• Myocardial Infarction 
• Nerve Injury 
• Pain 
• Pericardial Effusion 
• Pneumothorax
• Radiation Exposure 
• Respiratory Insufficiency/Failure 
• Thrombosis 
• Transient Ischemic Attack 
• Vasovagal Response 
• Vessel Trauma 

There may be other potential adverse events that are unforeseen at this time.

97186433 (Rev. E)