Development of a Beat to Beat Fetal Electrocardiogram

项目摘要 美国每年有24，000例死产，全世界每年有260万例死产， 近十年来大幅下降。胎儿心律异常，如长QT综合征，被认为 在这些死亡中起重要作用，并可能导致3-10%的不明原因死产。这是除了 已知的胎儿心律失常，每年影响1-3%的妊娠。心磁图是黄金 检测这些疾病的标准，但对于广泛使用来说并不便携或实用。其他可用工具 例如超声波和心脏分娩描记术不能测量诊断和引导所需的间隔 管理危及生命的心律失常。心律失常诊断和指导治疗的理想工具 心电图（ECG）。不幸的是，临床医生并没有广泛使用现有的胎儿心电图 （fECG）设备的原因有很多：它们在整个妊娠期都不工作， 心律失常，在实际节律和显示的节律之间有延迟，在多胎妊娠中不起作用， 并且缺乏重要间隔的分辨率。 我们的团队正在开发一种方法来检测连续的，时间分辨的fECG使用一种新的 自适应干扰消除（AIC）。这项建议将建立在我们的初步工作基础上， 创建fECG临床原型，并评估其在儿科医院孕产妇患者中的性能。 该设备设计用于生成fECG，无论胎龄、体位或妊娠是否涉及 多胎在本提案中，我们的目标是： 1.通过修改信号处理将工程原型fECG转换为临床原型 算法和用户界面使用现有的数据集。 2.测量16-40周妊娠胎儿的心脏时间间期，并评估其重复性 两个读者之间的距离。 如果成功的话，胎儿心脏病专家可以使用这个工具来诊断和治疗已知的和潜在的胎儿心律失常 与现有的抗癫痫治疗。在全球范围内，它可以作为一种低成本的工具来筛查心律失常， 并监测胎儿在手术、母体药物使用和胎儿 干预措施。临床上实施这一关键的诊断工具将是一个里程碑，在该领域的胎儿 心脏病学

Project Summary There are 24,000 stillbirths per year in the United States, and 2.6 million stillbirths per year worldwide, with no significant decrease in the last decade. Abnormal fetal heart rhythms, such as long QT syndrome, are thought to play an important role in these deaths, and may cause 3-10% of unexplained stillbirths. This is in addition to known fetal arrhythmias, which affect 1-3% of pregnancies per year. A magnetocardiogram is the gold standard to detect these disorders, but is not portable or practical for widespread use. Other available tools such as ultrasound and cardiotocography cannot measure the intervals needed to diagnose and guide management of life threatening arrhythmias. The ideal tool for diagnosing and guiding therapy for arrhythmias is an electrocardiogram (ECG). Unfortunately, clinicians do not widely use the existing fetal electrocardiogram (fECG) devices for a variety of reasons: they do not work throughout all of gestation, can miss brief arrhythmias, have a delay between the actual rhythm and displayed rhythm, do not work in multiple gestations, and lack resolution of important intervals. Our team is developing a methodology to detect a continuous, time-resolved fECG using a novel implementation of adaptive interference cancellation (AIC). This proposal will build on our preliminary work to create a fECG clinical prototype and evaluate its performance in maternal patients at our pediatric hospital. This device is designed to generate an fECG regardless of gestational age, position, or pregnancies involving multiple fetuses. In this proposal, we aim to: 1. Transition an engineering prototype fECG to a clinical prototype by modifying the signal processing algorithm and user interface using existing datasets. 2. Measure cardiac time intervals in 16-40 week gestation fetuses and assess the reproducibility of these measurements between two readers. If successful, fetal cardiologists could use this tool to diagnose and treat known and latent fetal arrhythmias with existing anti-arrhythmic therapies. Globally, it could serve as a low cost tool to screen for arrhythmias that lead to stillbirth and to monitor fetuses for compromise during surgery, maternal medication use, and fetal interventions. Clinically implementing this critical diagnostic tool will be a landmark in the field of fetal cardiology.