Carlijn Lempersz1, Judith O van Laar1,2, Sally-Ann B Clur3, Kim M Verdurmen1, Guy J Warmerdam2, Joris van der Post4, Nico A Blom3, Tammo Delhaas5, S Guid Oei1,2, Rik Vullings2. 1. Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands. 2. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 3. Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands. 4. Amsterdam University Medical Centre, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands. 5. Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
Abstract
INTRODUCTION: The examination of the fetal heart in mid-pregnancy is by ultrasound examination. The quality of the examination is highly dependent on the skill of the sonographer, fetal position and maternal body mass index. An additional tool that is less dependent on human experience and interpretation is desirable. The fetal electrocardiogram (ECG) could fulfill this purpose. We aimed to show the feasibility of recording a standardized fetal ECG in mid-pregnancy and explored its possibility to detect congenital heart disease (CHD). MATERIALS AND METHODS: Women older than 18 years of age with an uneventful pregnancy, carrying a healthy singleton fetus with a gestational age between 18 and 24 weeks were included. A fetal ECG was performed via electrodes on the maternal abdomen. After removal of interferences, a vectorcardiogram was constructed. Based on the ultrasound assessment of the fetal orientation, the vectorcardiogram was rotated to standardize for fetal orientation and converted into a 12-lead ECG. Median ECG waveforms for each lead were calculated. RESULTS: 328 fetal ECGs were recorded. 281 were available for analysis. The calculated median ECG waveform showed the electrical heart axis oriented to the right and inferiorly i.e. a negative QRS deflection in lead I and a positive deflection in lead aVF. The two CHD cases show ECG abnormalities when compared to the mean ECG of the healthy cohort. DISCUSSION: We have presented a method for estimating a standardized 12-lead fetal ECG. In mid-pregnancy, the median electrical heart axis is right inferiorly oriented in healthy fetuses. Future research should focus on fetuses with congenital heart disease.
INTRODUCTION: The examination of the fetal heart in mid-pregnancy is by ultrasound examination. The quality of the examination is highly dependent on the skill of the sonographer, fetal position and maternal body mass index. An additional tool that is less dependent on human experience and interpretation is desirable. The fetal electrocardiogram (ECG) could fulfill this purpose. We aimed to show the feasibility of recording a standardized fetal ECG in mid-pregnancy and explored its possibility to detect congenital heart disease (CHD). MATERIALS AND METHODS:Women older than 18 years of age with an uneventful pregnancy, carrying a healthy singleton fetus with a gestational age between 18 and 24 weeks were included. A fetal ECG was performed via electrodes on the maternal abdomen. After removal of interferences, a vectorcardiogram was constructed. Based on the ultrasound assessment of the fetal orientation, the vectorcardiogram was rotated to standardize for fetal orientation and converted into a 12-lead ECG. Median ECG waveforms for each lead were calculated. RESULTS: 328 fetal ECGs were recorded. 281 were available for analysis. The calculated median ECG waveform showed the electrical heart axis oriented to the right and inferiorly i.e. a negative QRS deflection in lead I and a positive deflection in lead aVF. The two CHD cases show ECG abnormalities when compared to the mean ECG of the healthy cohort. DISCUSSION: We have presented a method for estimating a standardized 12-lead fetal ECG. In mid-pregnancy, the median electrical heart axis is right inferiorly oriented in healthy fetuses. Future research should focus on fetuses with congenital heart disease.
Authors: S C Chivers; T Vasavan; M Nandi; B R Hayes-Gill; I A Jayawardane; J M Simpson; C Williamson; W P Fifer; M Lucchini Journal: JRSM Cardiovasc Dis Date: 2022-05-11
Authors: L Noben; C Lempersz; E R van den Heuvel; Z Zhan; F P H A Vandenbussche; A B C Coumans; M C Haak; R Vullings; S G Oei; S A B Clur; J O E H van Laar Journal: PLoS One Date: 2022-10-20 Impact factor: 3.752
Authors: Carlijn Lempersz; Lore Noben; Sally-Ann B Clur; Edwin van den Heuvel; Zhouzhao Zhan; Monique Haak; S Guid Oei; Rik Vullings; Judith O E H van Laar Journal: PLoS One Date: 2021-12-16 Impact factor: 3.240