The final common pathway to death in all of us is an arrhythmia, yet we still know far too little about the contribution of conduction abnormalities and arrhythmias to the compromised states of the human fetus. At no other time in the human life cycle is the human being at more risk of unexplained and unexpected death than during the prenatal period. The risk of sudden death from 20-40 weeks gestation is 6-12 deaths/1000 fetuses/year. This is equal to, and in some ethnic groups HIGHER than, the risk of death in the adult population with known coronary artery disease over the same time frame (6-12 deaths/1000 patients/year). Because only a small percentage of the United States population is pregnant each year, because fetal demise is not often acknowledged through public displays such as funerals, and finally because fetal death is culturally accepted to a much greater extent than it should be, this critically important area of women's healthcare has not had the technological advances that have been seen in adult cardiac intensive care and other areas of medicine. Fetal cardiac deaths may be preventable and the diseases that lead to these deaths are often treatable, especially if the sophistication of our modern ICU's could somehow be translated to the prenatal monitoring arena. This review article will outline recent advances in evaluating fetal electrophysiology, helping the perinatologist to better understand the nuances of fetal arrhythmias.
The failing adult heart is known to revert to fetal patterns of contractile protein expression during pathologic remodeling, yet very little is known about the electrophysiology or electromechanics of the living human fetal heart during normal prenatal development or during stress. This owes largely to the inability to easily record the fetal electrocardiogram (fECG). While fetal echocardiography provides mechanical assessment of heart rhythm, it does not provide details of the electrophysiology of the fetal heart. These details, along with the genetics of fetal and neonatal demise, are emerging as potential leading factors in defining prenatal sudden death risk. While echocardiography has been utilized extensively for 20 years in prenatal high risk screening, it has not had the desired outcome in reducing overall fetal sudden death to the extent that sudden death has been reduced in the infant, child, and adult. Late gestation unexplained fetal death costs 26,000 fetal lives yearly in the United States and over 4 million fetal lives each year worldwide. Fetal Magnetocardiography (fMCG) opens a new window in fetal healthcare assessment. Fetal cardiac deaths may be preventable because the diseases that lead to these deaths are often treatable, especially if the sophisticated modern ICU monitoring and management techniques could be translated to the field of prenatal care. Fetal MagnetocardiographyFetal magnetocardiography (fMCG) is a noninvasive technique for recording magnetic fields generated by the electrical activity of the fetal heart. Unlike fetal MRI, fMCG does not emit magnetic fields or energy. It is a passive and safe recording technique, analogous to the ECG, utilizing the extremely high sensitivity Superconducting Quantum Interference Device (SQUID) sensors. These sensors amplify signals that are naturally occurring and extremely weak-on the order of 10 −12 tesla, much smaller than environmental magnetic interference.
Introduction: Fetal magnetocardiography (fMCG) is a promising new technique for assessing fetal rhythm; however, no prior studies have utilized fMCG to evaluate human fetal electromechanical physiology. Pre-ejection period (PEP) is an important measure of the electromechanical activation of the heart, and is altered by disease states and arrhythmias. Materials and Methods: A novel technique was used to assess fetal PEP and its relationship to other fetal systolic time intervals, RR interval, and gestational age (GA). 25 normal human fetuses between 19 and 38 weeks’ gestation were studied using simultaneous pulsed Doppler ultrasound and fMCG. Correlations among PEP, ejection time, QRS width and RR interval were assessed using linear regression. Results: Across all subjects, PEP was found to correlate with GA (R = 0.57, p < 0.0001), QRS width (R = 0.35, p = 0.026), and RR interval (R = 0.37, p = 0.018). In individual sessions, PEP negatively correlated beat-to-beat with the preceding RR interval. Conclusion: PEP exhibits developmental trends that provide a better understanding of the normal development of the human fetal heart.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.