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Feasibility of Non-invasive Fetal Electrocardiographic Interval Measurement in the Outpatient Clinical Setting

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Abstract

Non-invasive fetal electrocardiography (ECG) is a promising method for evaluating fetal cardiac electrical activity. Despite advances in fetal ECG technology, its ability to provide reliable, interpretable results in a typical outpatient fetal cardiology setting remains unclear. We sought to determine the feasibility of measuring standard ECG intervals in an outpatient fetal cardiology practice using an abdominal fetal ECG device that employs blind source separation with reference, an innovative signal-processing technique for fetal ECG extraction. Women scheduled for clinically indicated outpatient fetal echocardiogram underwent 10 min of fetal ECG acquisition from the maternal abdomen using specialized gel electrodes. A bedside laptop computer performed fetal ECG extraction, allowing real-time visualization of fetal and maternal ECG signals. Offline post-processing of 1 min of recorded data yielded fetal P-wave duration, PR interval, QRS duration, RR interval, QT interval, and QTc. Fifty-five fetuses were studied with gestational age 18–37 weeks, including 13 with abnormal fetal echocardiogram findings and three sets of twins. Interpretable results were obtained in 91% of fetuses, including 85% during the vernix period and 100% of twin fetuses. PR interval and RR interval of 18–24 week gestation fetuses were significantly shorter than those with gestational age 25–31 and 32–37 weeks. Of the six fetuses with abnormal rhythms on fetal echocardiogram, fetal ECG tracing was interpretable in five and matched the rhythm noted on fetal echocardiogram. Abdominal fetal ECG acquisition is feasible for arrhythmia detection and ECG interval calculation in a routine clinical setting.

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Acknowledgements

The authors acknowledge Shizu Shoji, Rika Kamamoto, Kunihiro Koide, and Namareq Widatalla for their assistance with data processing and analysis.

Funding

This work was supported by the Developmental Disorder Data Multi-level Integration Unit of Medical Sciences Innovation Hub Program (MIH), RIKEN (to Tohoku University), and philanthropic funding to the cardiology patient research fund at Children’s National Medical Center (SPF 44563).

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Author notes

  1. Ashish N. Doshi

    Present address: Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, Hackerman Hall Room 208, Baltimore, MD, 21218, USA

Authors and Affiliations

  1. Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA

    Ashish N. Doshi, Jeffrey P. Moak & Anita Krishnan

  2. Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA

    Paige Mass & Kevin R. Cleary

  3. Advanced Interdisciplinary Biomedical Engineering, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan

    Kiyoe Funamoto & Yoshitaka Kimura

  4. Department of Biomedical Engineering, Khalifa University of Science and Technology, PO Box 127788, Abu Dhabi, United Arab Emirates

    Ahsan H. Khandoker

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  1. Ashish N. Doshi
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Correspondence to Ashish N. Doshi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Doshi, A.N., Mass, P., Cleary, K.R. et al. Feasibility of Non-invasive Fetal Electrocardiographic Interval Measurement in the Outpatient Clinical Setting. Pediatr Cardiol 40, 1175–1182 (2019). https://doi.org/10.1007/s00246-019-02128-w

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  • DOI: https://doi.org/10.1007/s00246-019-02128-w

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