Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting
Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting
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DOI：
10.1007/s00246-015-1118-4
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发表时间：
2015-06-01
影响因子：
1.6
通讯作者：
Donofrio, Mary T.
中科院分区：
文献类型：
--
作者：
Arya, Bhawna;Govindan, Rathinaswamy;Donofrio, Mary T.
心律是胎儿心脏评估的重要组成部分。Monica AN24是一种胎儿心率监测仪，可以提供一种快速、廉价的方式，在临床环境中获得无创胎儿心电图（fECG）。fECG设备能够获取fECG信号，并允许计算16至42周胎龄（GA）之间的胎儿心脏时间间隔。我们的目的是证明在一个繁忙的胎儿心脏病诊所使用莫妮卡胎儿心率监测仪获取feg的可行性。这是一项前瞻性观察性的初步研究，从胎儿超声心动图中获得feg。录音时间为5-15分钟。母体信号减弱，fECG平均。fECG和胎儿心脏时间间隔（PR、QRS、RR和QT）由两位心脏病专家独立评估，观察者间信度采用类内系数（ICC）评估。从50位母亲中采集60个fecg（平均GA 28.1 +/- A 6.1）。在20项研究中，259个心脏周期获得了足够的信号平均波形。在26至30周之间无法获得波形。测量胎儿心脏时间间隔，PR （ICC = 0.89; CI 0.77-0.94）、QRS （ICC = 0.79; CI 0.51-0.91）和RR （ICC = 0.77; CI 0.53-0.88）均可重复。QT ICC由于t波跟踪不理想而较差。在妊娠期19- 42周的临床环境中，胎儿心脏时间间隔的获取和测量是可行的，尽管追踪很难获得，特别是在26 - 30周之间。除了QT外，胎儿心脏时间间隔测量的可靠性很高。该设备可用于评估20至26周和50至30周胎儿的房室/室内传导。改进信号采集的技术，即t波放大，正在进行中。
Cardiac rhythm is an essential component of fetal cardiac evaluation. The Monica AN24 is a fetal heart rate monitor that may provide a quick, inexpensive modality for obtaining a noninvasive fetal electrocardiogram (fECG) in a clinical setting. The fECG device has the ability to acquire fECG signals and allow calculation of fetal cardiac time intervals between 16- and 42-week gestational age (GA). We aimed to demonstrate the feasibility of fECG acquisition in a busy fetal cardiology clinic using the Monica fetal heart rate monitor. This is a prospective observational pilot study of fECG acquired from fetuses referred for fetal echocardiography. Recordings were performed for 5-15 min. Maternal signals were attenuated and fECG averaged. fECG and fetal cardiac time intervals (PR, QRS, RR, and QT) were evaluated by two cardiologists independently and inter-observer reliability was assessed using intraclass coefficient (ICC). Sixty fECGs were collected from 50 mothers (mean GA 28.1 +/- A 6.1). Adequate signal-averaged waveforms were obtained in 20 studies with 259 cardiac cycles. Waveforms could not be obtained between 26 and 30 weeks. Fetal cardiac time intervals were measured and were reproducible for PR (ICC = 0.89; CI 0.77-0.94), QRS (ICC = 0.79; CI 0.51-0.91), and RR (ICC = 0.77; CI 0.53-0.88). QT ICC was poor due to suboptimal T-wave tracings. Acquisition of fECG and measurement of fetal cardiac time intervals is feasible in a clinical setting between 19- and 42-week GA, though tracings are difficult to obtain, especially between 26 and 30 weeks. There was high reliability in fetal cardiac time intervals measurements, except for QT. The device may be useful for assessing atrioventricular/intraventricular conduction in fetuses from 20 to 26 and > 30 weeks. Techniques to improve signal acquisition, namely T-wave amplification, are ongoing.