Noninvasive fetal electrocardiography for the detection of fetal arrhythmias. (29th January 2019)

• Record Type: Journal Article
• Authors: Behar, Joachim A.; Bonnemains, Laurent; Shulgin, Vyacheslav; Oster, Julien; Ostras, Oleksii; Lakhno, Igor
• Is Part Of: Prenatal diagnosis. Volume 39:Number 3(2019)
• Page Start: 178
• Page End: 187
• Publication Date: 2019-01-29
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5412
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To assess whether noninvasive fetal electrocardiography (NI‐FECG) enables the diagnosis of fetal arrhythmias. Methods: A total of 500 echocardiography and NI‐FECG recordings were collected from pregnant women during a routine medical visit in this multicenter study. All the cases with fetal arrhythmias (n = 12) and a matching number of control (n = 14) were used. Two perinatal cardiologists analyzed the extracted NI‐FECG while blinded to the echocardiography. The NI‐FECG‐based diagnosis was compared with the reference fetal echocardiography diagnosis. Results: NI‐FECG and fetal echocardiography agreed on all cases (Ac = 100%) on the presence of an arrhythmia or not. However, in one case, the type of arrhythmia identified by the NI‐FECG was incorrect because of the low resolution of the extracted fetal P‐wave, which prevented resolving the mechanism (2:1 atrioventricular conduction) of the atrial tachycardia. Conclusion: It is possible to diagnose fetal arrhythmias using the NI‐FECG technique. However, this study identifies that improvement in algorithms for reconstructing the P‐wave is critical to systematically resolve the mechanisms underlying the arrhythmias. The elaboration of a NI‐FECG Holter device will offer new opportunities for fetal diagnosis and remote monitoring of problematic pregnancies because of its low‐cost, noninvasiveness, portability, and minimal setup requirements. Abstract : What's already known about this topic? Several studies have shown the ability of NI‐FECG to accurately estimate the fetal heart rate. Some studies showed that conduction information can be retrieved from the morphology of the reconstructed NI‐FECG. However, the potential of NI‐FECG for providing clinically actionable information has rarely been assessed. What does this study add? We show, for the first time, that NI‐FECG allows to identify fetal arrhythmias and in most cases provides additional information on the rhythm disturbances than echocardiography. We identify the main engineering issues remaining in the current state of the technology for making NI‐FECG a competitive diagnosis and monitoring option. We provide a unique open access dataset of NI‐FECG with arrhythmias. This will allow further research and reproducibility of our analysis.