The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography

Abstract

Objectives To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation. Methods Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection. Results The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively. Conclusion The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect. Trial registration Clinical trial registration number: NL48535.015.14.

Fetal electrocardiography and artificial intelligence for prenatal detection of congenital heart disease

“…In the past, artificial intelligence has been adopted for the classification of CHD from fetal cardiac ultrasound images 30 as well as from fetal heart sounds, 31 and the combination of neonatal ECGs with artificial intelligence has also shown great promise 32,33 . Even though the fetal ECG was shown to be a reliable method for determining the fetal heartrate during labor, 34 little research on the detection of CHD with fetal ECG has been performed because of challenges in both the acquisition and interpretation of the fetal ECG 35–37 . Combining the potential of artificial intelligence and leveraging recent advancements in the measurement of non‐invasive fetal ECG, we investigate a novel method for the antenatal detection of CHD.…”

“… 32 , 33 Even though the fetal ECG was shown to be a reliable method for determining the fetal heartrate during labor, 34 little research on the detection of CHD with fetal ECG has been performed because of challenges in both the acquisition and interpretation of the fetal ECG. 35 , 36 , 37 Combining the potential of artificial intelligence and leveraging recent advancements in the measurement of non‐invasive fetal ECG, we investigate a novel method for the antenatal detection of CHD.…”