Orientation of the electrical heart axis in mid-term pregnancy

Verdurmen, Kmj Kim; Hulsenboom, Adj Alexandra; Laar, Joeh Judith van; Wijn, Pff Pieter; Vullings, Rik; Oei, S.G.

doi:10.1016/j.ejogrb.2016.10.030

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…These haemodynamic differences can influence fetal ECG morphology. Previous research has shown that the electrical heart axis of the fetus points toward the right 35. Until now, only a few studies have been published studying fetal ECG waveform characteristics 36–43.…”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of a bundle branch block based on the fetal ECG

Noben¹,

Clur

Laar

et al. 2019

BMJ Case Rep

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A non-invasive fetal ECG was performed on a 36-year-old pregnant woman at 24+6 weeks of gestation as part of ongoing clinical research. A paediatric cardiologist suspected an incomplete bundle branch block based on the averaged ECGs from the recording. The characteristic terminal R’ wave was present in multiple leads of the fetal ECGs. A fetal anomaly scan had been performed at 20 weeks of gestation and showed no abnormalities. An incomplete right bundle branch block was confirmed on an ECG recorded at the age of 2 years. This case shows the possibility of novel non-invasive fetal ECG technology as an adjunct to the diagnosis of fetal cardiac anomalies in the future.

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Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of a bundle branch block based on the fetal ECG

Noben¹,

Clur

Laar

et al. 2019

BMJ Case Rep

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“…In the fetus, the right ventricle plays the dominant role in perfusing the systemic circulation. As a result, the fetal cardiac axis points towards the right in the fetus in contrast to the left-sided deviation in the adults [ 28 ]. This difference in orientation results in the FECG appearing morphologically different from an adult ECG [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of cardiac time intervals utilising non-invasive fetal electrocardiogram in normal fetuses

Smith

Arunthavanathan

Nair

et al. 2018

BMC Pregnancy Childbirth

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BackgroundNon-invasive fetal electrocardiogram (NIFECG) is an evolving technology in fetal surveillance which is attracting increasing research interest. There is however, only limited data outlining the reference ranges for normal cardiac time intervals (CTIs). The objective of our group was to carry out a systematic review to outline normal fetal CTIs using NIFECG.MethodsA systematic review of peer reviewed literature was performed, searching PUBMED,Ovid MEDLINE and EMBASE. The outcomes of interest included fetal CTIs (P wave duration, PR interval, QRS duration and QT interval) and a descriptive summary of relevant studies as well. The outcomes were grouped as early pre-term (≤ 32 weeks), moderate to late pre-term (32–37 weeks) and term (37–41 weeks).Results8 studies were identified as suitable for inclusion. Reference ranges of CTIs were generated. Both PR interval and QRS duration demonstrated a linear correlation with advancing gestation. Several studies also demonstrated a reduction in signal acquisition between 27 and 32 weeks due to the attenuation by vernix caseosa. In this group, both the P wave and T waves were difficult to detect due to signal strength and interference.ConclusionNIFECG demonstrates utility to quantify CTIs in the fetus, particularly at advanced gestations. Larger prospective studies should be directed towards establishing reliable CTIs across various gestations.

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“…A second possibility for a poor performance of the STAN device is related to the fetal electrical heart axis. The orientation of the fetal electrical heart axis differs greatly among fetuses [ 27 ]. The electrical heart axis affects the height of the T/QRS baseline and therefore the incidence of ST events.…”

Section: Discussionmentioning

confidence: 99%

ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion

et al. 2018

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IntroductionThe inconclusive clinical results for ST-waveform analysis (STAN) in detecting fetal hypoxemia may be caused by the signal processing of the STAN-device itself. We assessed the performance of a clinical STAN device in signal processing and in detecting hypoxemia in a fetal sheep model exposed to prolonged umbilical cord occlusion (UCO).MethodsEight fetal lambs were exposed to 25 minutes of UCO. ECG recordings were analyzed during a baseline period and during UCO. STAN-event rates and timing of episodic T/QRS rise, baseline T/QRS rise and the occurrence of biphasic ST-waveforms, as well as signal loss, were assessed.ResultsDuring baseline conditions of normoxemia, a median of 40 (IQR, 25–70) STAN-events per minute were detected, compared to 10 (IQR, 2–22) during UCO. During UCO STAN-events were detected in five subjects within 10 minutes and in six subjects after 18 minutes, respectively. Two subjects did not generate any STAN-event during UCO. Biphasic ST event rate was reduced during UCO (median 0, IQR 0–5), compared to baseline (median 32, IQR, 6–55). ST-waveforms could not be assessed in 62% of the recording time during UCO, despite a good quality of the ECG signal.ConclusionsThe STAN device showed limitations in detecting hypoxemia in fetal sheep after prolonged UCO. The STAN device produced high false positive event rates during baseline and did not detect T/QRS changes adequately after prolonged fetal hypoxemia. During 14% of baseline and 62% of the UCO period, the STAN-device could not process the ECG signal, despite its good quality. Resolving these issues may improve the clinical performance of the STAN device.

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Orientation of the electrical heart axis in mid-term pregnancy

Cited by 14 publications

References 13 publications

Prenatal diagnosis of a bundle branch block based on the fetal ECG

Prenatal diagnosis of a bundle branch block based on the fetal ECG

A systematic review of cardiac time intervals utilising non-invasive fetal electrocardiogram in normal fetuses

ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion

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