The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography

L Noben; C Lempersz; E R van den Heuvel; Z Zhan; F P H A Vandenbussche; A B C Coumans; M C Haak; R Vullings; S G Oei; S A B Clur; J O E H van Laar

doi:10.1371/journal.pone.0275802

The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography

PLoS One. 2022 Oct 20;17(10):e0275802. doi: 10.1371/journal.pone.0275802. eCollection 2022.

Authors

L Noben^{1

2}, C Lempersz^{1

2}, E R van den Heuvel³, Z Zhan³, F P H A Vandenbussche⁴, A B C Coumans⁵, M C Haak⁶, R Vullings^{1

7}, S G Oei^{1

2

7}, S A B Clur⁸, J O E H van Laar^{1

2

8}

Affiliations

¹ Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
² Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.
³ Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
⁴ Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁶ Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
⁸ Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

Abstract

Objectives: To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation.

Methods: Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection.

Results: The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively.

Conclusion: The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect.

Trial registration: Clinical trial registration number: NL48535.015.14.

MeSH terms

Electrocardiography
Female
Fetal Heart / diagnostic imaging
Fetus
Heart Defects, Congenital* / diagnostic imaging
Heart Septal Defects*
Humans
Pregnancy
Ultrasonography, Prenatal

Supplementary concepts

Atrioventricular Septal Defect

Grants and funding

The author(s) received no specific funding for this work.