Наукові праці. Кафедра акушерства та гінекології № 3

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Non-invasive fetal electrocardiography for the detection of fetal arrhythmias: Toward a fetal Holter
(Elsevier, 2018-09-03) Behar, Joachim; Bonnemains, Laurent; Shulgin, Vyacheslav; Oster, Julien; Ostras, Oleksii; Lakhno, Igor
Background Non-invasive fetal ECG is a promising low-cost and non-invasive continuous fetal monitoring technique. Objective In this work, we explore the potential of non-invasive fetal electrocardiography as a novel technique for fetal arrhythmias diagnoses. Study design The population of this prospective study comprised 12 arrhythmic fetus and 14 normal ones, according to a routine fetal echocardiography. We diagnosed the fetal cardiac rhythm of the 26 fetuses using the non-invasive fetal ECG and compared it to the echocardiographic reference diagnosis. For this purpose, extraction of the non-invasive fetal ECG and detection of abnormal rhythm events were performed automatically. Two perinatal cardiologists, blinded to the echocardiographic diagnosis, analyzed these events. Results Diagnosis based on the non-invasive fetal ECG recognized the following rhythm disorders: 6 cases with extrasystoles, 2 tachyarrhythmia, 1 bradyarrhythmia, 1 irregular atrial rhythm and 1 case with blocked P-waves (Fig. 1). Non-invasive fetal ECG and fetal echocardiography agreed on all cases (26/26) on whether the fetus had normal rhythm or an arrhythmia. However, in one arrhythmic case the ECG miss-diagnosed the fetus with sinusal pauses although it had been diagnosed with atrial tachycardia with variable conduction by echocardiography. Conclusion The non-invasive fetal ECG allowed to diagnose for fetal arrhythmias and in most cases provided refinement on the arrhythmias when compared to fetal echocardiography. This is mainly due to the longer recording time and the possibility to automate the detection of abnormal rhythm events. However, in some cases the low resolution of the P-wave in the ECG traces (Fig. 2) made it difficult to resolve the mechanism behind the arrhythmia and in one case the low P-wave resolution leaded to an inaccurate diagnosis. The low-resolution of the extracted P-wave represents the main challenge for improving the diagnostic performance of fetal ECG. This paper is a proof of concept and a first step toward the creation of a fetal Holter ECG device. Such a device will offer new opportunities for fetal diagnosis and monitoring because it is low-cost, non-invasive, requires a minimal set-up, and can enable the detection of both persistent and intermittent fetal cardiac rhythm disorders.
Noninvasive fetal electrocardiography for the detection of fetal arrhythmias
(John Wiley and Sons Ltd., 2019-01-02) Behar, Joachim; Bonnemains, Laurent; Shulgin, Vyacheslav; Oster, Julien; Ostras, Oleksii; Lakhno, Igor
Objective: To assess whether noninvasive fetal electrocardiography (NI‐FECG) enables the diagnosis of fetal arrhythmias. Methods: A total of 500 echocardiography and NI‐FECG recordings were collected from pregnant women during a routine medical visit in this multicenter study. All the cases with fetal arrhythmias (n = 12) and a matching number of control (n = 14) were used. Two perinatal cardiologists analyzed the extracted NI‐FECG while blinded to the echocardiography. The NI‐FECG‐based diagnosis was compared with the reference fetal echocardiography diagnosis. Results: NI‐FECG and fetal echocardiography agreed on all cases (Ac = 100%) on the presence of an arrhythmia or not. However, in one case, the type of arrhythmia identified by the NI‐FECG was incorrect because of the low resolution of the extracted fetal P‐wave, which prevented resolving the mechanism (2:1 atrioventricular conduction) of the atrial tachycardia. Conclusion: It is possible to diagnose fetal arrhythmias using the NI‐FECG technique. However, this study identifies that improvement in algorithms for reconstructing the P‐wave is critical to systematically resolve the mechanisms underlying the arrhythmias. The elaboration of a NI‐FECG Holter device will offer new opportunities for fetal diagnosis and remote monitoring of problematic pregnancies because of its low‐cost, noninvasiveness, portability, and minimal setup requirements.