Key result
In healthy fetuses between 18 and 24 weeks of gestation, the average electrical heart axis in the frontal plane was oriented to the right at 122.7 degrees, with a wide 90% prediction interval of -25.6 to 270.9 degrees.
Why the study?
Mid-pregnancy anomaly scans miss 40% of congenital heart disease, and reference values for the fetal electrical heart axis around 20 weeks of gestation are needed to potentially boost detection rates.
Cohort (n=281)
Yes
The average electrical heart axis of healthy fetuses around mid-gestation is oriented to the right (122.7°), providing reference values that may aid in the detection of congenital heart disease using non-invasive fetal ECG.
Normative fetal ECG axis values at mid-gestation; hypothesis-generating for congenital heart disease detection and requires prospective validation.
INTRODUCTION: A fetal anomaly scan in mid-pregnancy is performed, to check for the presence of congenital anomalies, including congenital heart disease (CHD). Unfortunately, 40% of CHD is still missed. The combined use of ultrasound and electrocardiography might boost detection rates. The electrical heart axis is one of the characteristics which can be deduced from an electrocardiogram (ECG). The aim of this study was to determine reference values for the electrical heart axis in healthy fetuses around 20 weeks of gestation. MATERIAL AND METHODS: Non-invasive fetal electrocardiography was performed subsequent to the fetal anomaly scan in pregnant women carrying a healthy singleton fetus between 18 and 24 weeks of gestation. Eight adhesive electrodes were applied on the maternal abdomen including one ground and one reference electrode, yielding six channels of bipolar electrophysiological measurements. After removal of interferences, a fetal vectorcardiogram was calculated and then corrected for fetal orientation. The orientation of the electrical heart axis was determined from this normalized fetal vectorcardiogram. Descriptive statistics were used on normalized cartesian coordinates to determine the average electrical heart axis in the frontal plane. Furthermore, 90% prediction intervals (PI) for abnormality were calculated. RESULTS: Of the 328 fetal ECGs performed, 281 were included in the analysis. The average electrical heart axis in the frontal plane was determined at 122.7° (90% PI: -25.6°; 270.9°). DISCUSSION: The average electrical heart axis of healthy fetuses around mid-gestation is oriented to the right, which is, due to the unique fetal circulation, in line with muscle distribution in the fetal heart.
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Lempersz et al. (2021) conducted a cohort in Healthy singleton fetus (n=281). Non-invasive fetal electrocardiography was evaluated on Average electrical heart axis in the frontal plane (95% CI -25.6 to 270.9). In healthy fetuses between 18 and 24 weeks of gestation, the average electrical heart axis in the frontal plane was oriented to the right at 122.7 degrees, with a wide 90% prediction interval of -25.6 to 270.9 degrees.
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