Understanding congenital heart defects through abdominal fetal electrocardiography: Case reports and clinical implications

Velayo, Clarissa; Sato, Nobuko; Ito, Takehiro; Chisaka, Hiroshi; Yaegashi, Nobuo; Okamura, Koji; Kimura, Yoshitaka

doi:10.1111/j.1447-0756.2010.01367.x

Cited by 21 publications

(25 citation statements)

References 18 publications

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“…Both these electrocardiographic parameters represent depolarization and repolarization of the ventricles and have been used as an indicator for deteriorating ventricular performance (Martin et al, 1994). These findings were consistent with earlier published data by Velayo et al evaluating abdominal fetal electrocardiography in congenital heart defects (CHD) in singleton pregnancies wherein certain cardiac pathologies exhibited particular ECG changes (Velayo et al, 2011). For example, PR and QTc intervals were prolonged in fetuses with dilated cardiomyopathy (DCM).…”

Section: Discussionsupporting

confidence: 92%

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

et al. 2017

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Objectives: This descriptive study was performed to evaluate the capability of a non-invasive transabdominal electrocardiographic system to extract clear fetal electrocardiographic (FECG) measurements from intrauterine growth restricted (IUGR) fetuses and to assess whether abdominal FECG parameters can be developed as markers for evaluating the fetal cardiac status in IUGR.Methods: Transabdominal FECG was attempted in 20 controls and 15 IUGR singleton pregnancies at 20+0−33+6 weeks gestation. Standard ECG parameters were compared between the study groups and evaluated for their correlation. Accuracy for the prediction of IUGR by cut off values of the different FECG parameters was also determined.Results: Clear P-QRST complexes were recognized in all cases. In the IUGR fetuses, the QT and QTc intervals were significantly prolonged (p = 0.017 and p = 0.002, respectively). There was no correlation between ECG parameters and Doppler or other indices to predict IUGR. The generation of cut off values for detecting IUGR showed increasing sensitivities but decreasing specificities with the prolongation of ECG parameters.Conclusion: The study of fetal electrocardiophysiology is now feasible through a non-invasive transabdominal route. This study confirms the potential of FECG as a clinical screening tool to aid diagnosis and management of fetuses after key limitations are addressed. In the case of IUGR, both QT and QTc intervals were significantly prolonged and thus validate earlier study findings where both these parameters were found to be markers of diastolic dysfunction. This research is a useful prelude to a test of accuracy and Receiver Operating Characteristics (ROC) study.

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Section: Discussionsupporting

confidence: 92%

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

et al. 2017

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“…334 With this technique, T-wave amplitude was noted to be increased during states of asphyxia; these changes were believed to be attributable to myocardial potassium liberation during glycolysis. 335 Results of several randomized, clinical trials using fetal electrocardiography involving >15 000 patients after 36 weeks' gestation [336][337][338] have shown variable results in the outcome measures of reduction in metabolic acidosis, decrease in moderate/severe neonatal encephalopathy, and operative delivery rate. Although the use of fetal electrocardiography may be reasonable to consider in the assessment of cardiac conduction and rhythm in fetuses with known or suspected diseases of the conduction system, its utility has not been established.…”

Section: Fetal Electrocardiographymentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

994

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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“…In the fetal outcome, atrioventricular septal defect (AVSD) was noted. Arrhythmia such as PVC in this case as observed throughout pregnancy may be a marker for a congenital heart defect [5]. Meanwhile, a transient case of arrhythmia is usually functional arrhythmia caused by physiological phenomena such as hyper-activation of ion channels in the fetal myocardial cell.…”

Section: Fetal Arrhythmiamentioning

confidence: 99%

“…For this, fetal ECG would be an ideal method for diagnosis, but the detection of P and T waves still need averaging over a number of cardiac cycles, which ultimately restricts its usage in this type of fetal arrhythmia detection. We are currently developing a new method for the diagnosis of ectopic heart beats by using fetal ECG with continuous Doppler signals [5,7].…”

Section: Fetal Arrhythmiamentioning

confidence: 99%

Recent Advances in Fetal Electrocardiography

Kimura¹,

Sato²,

Sugawara

et al. 2012

TOMDJ

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Abstract:Since the first observations of Cremer in 1906, fetal electrocardiogram (ECG) measurements via the maternal abdominal wall have remained a formidable challenge for clinical technicians and engineers in the cutting-edge field of information theory.Previous obstacles in extracting fetal ECG still complicate their acquisition at the present. These include three main difficulties for non-invasive measurement of fetal ECG: first, the low signal to noise ratio; second, the lack of a standard lead system for fetal ECG on the maternal abdomen; and third, the factor of fetal movement or non-stationarity during recording. A new extraction system based on blind source separation with reference signals (BSSR) was utilized and our detection rates, both off-line (91%) and on-line (60%), in pregnancies of 20 to 41 weeks of gestation have shown a marked improvement from earlier attempts. With this development, we discuss the potentials and limitations of this new system.

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Understanding congenital heart defects through abdominal fetal electrocardiography: Case reports and clinical implications

Abstract: In practice, similar findings found on FECG should raise the index of suspicion for the presence of congenital heart disease and prompt a targeted ultrasound scan.

Cited by 21 publications

References 18 publications

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

Diagnosis and Treatment of Fetal Cardiac Disease

Recent Advances in Fetal Electrocardiography

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