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Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting

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Abstract

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 ± 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.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical standard

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Division of Cardiology, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, M/S RC.2.820, PO Box 5371, Seattle, WA, 98105, USA

    Bhawna Arya

  2. Divisions of Fetal Medicine, Children’s National Medical Center, Washington, DC, USA

    Rathinaswamy Govindan, Adre Duplessis & Mary T. Donofrio

  3. Divisions of Cardiology, Children’s National Medical Center, Washington, DC, USA

    Anita Krishnan & Mary T. Donofrio

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  1. Bhawna Arya
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  2. Rathinaswamy Govindan
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  3. Anita Krishnan
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  4. Adre Duplessis
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  5. Mary T. Donofrio
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Correspondence to Bhawna Arya.

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Arya, B., Govindan, R., Krishnan, A. et al. Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting. Pediatr Cardiol 36, 1042–1049 (2015). https://doi.org/10.1007/s00246-015-1118-4

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  • DOI: https://doi.org/10.1007/s00246-015-1118-4

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