Development of a Beat to Beat Fetal Electrocardiogram

项目摘要 美国每年有2.4万例死产，全球每年有260万例死产，没有 在过去的十年中显著下降。异常的胎儿心率，如长QT综合征，被认为是 在这些死亡中发挥重要作用，并可能导致3%-10%的不明原因死产。这是对 已知的胎儿心律失常，每年影响1-3%的怀孕。心磁图就是黄金 检测这些疾病的标准，但不便于携带或广泛使用。其他可用的工具 例如超声波和心电监护不能测量诊断和指导所需的间隔 危及生命的心律失常的处理。诊断和指导治疗心律失常的理想工具 是一种心电图机。不幸的是，临床医生并没有广泛使用现有的胎儿心电图仪 (胎心电信号)设备有多种原因：它们不能在整个怀孕过程中工作，可能会错过短暂的 心律失常，在实际节律和显示的节律之间有延迟，在多个妊娠中不起作用， 缺乏重要区间的分辨率。 我们的团队正在开发一种方法，使用一种新颖的方法来检测连续的、时间分辨的胎儿心电 自适应干扰消除(AIC)的实现。这项建议将建立在我们初步工作的基础上，以 在儿科医院建立胎儿心电临床样机，并评估其在产妇中的表现。 这种设备的设计是为了产生胎心电信号，而不考虑胎龄、体位或怀孕情况。 多个胎儿。在这项建议中，我们的目标是： 1.通过修改信号处理将工程原型胎儿心电转换为临床原型 使用现有数据集的算法和用户界面。 2.测量16-40周妊娠胎儿的心脏时间间隔，并评估其重复性 两个读卡器之间的测量。 如果成功，胎儿心脏病学家可以使用这种工具来诊断和治疗已知的和潜在的胎儿心律失常 现有的抗心律失常疗法。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 导致死产，并监测胎儿在手术中的危害、产妇用药和胎儿 干预措施。临床应用这一关键诊断工具将是胎儿疾病领域的一个里程碑 心脏科。

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.