Key result
Fetoscopic transesophageal electrocardiography was successfully recorded in 100% of fetal sheep (10/10), with pacing capture documented in 7 fetuses, demonstrating procedural feasibility.
Why the study?
Does fetoscopic transesophageal electrocardiography and stimulation allow for successful recording and pacing in fetal sheep?
Does fetoscopic transesophageal electrocardiography and stimulation allow for successful recording and pacing in fetal sheep?
Fetoscopic fetal transesophageal electrocardiography and stimulation are feasible in fetal sheep, suggesting a potential minimally invasive approach for managing therapy-refractory supraventricular tachycardias in human fetuses.
Feasibility in fetal sheep is hypothesis-generating; human translation for fetal SVT remains untested.
BACKGROUND: Therapy-refractory supraventricular tachycardia commonly results in hydrops and death in human fetuses. The purpose of this study in fetal sheep was to assess the feasibility of a minimally invasive fetoscopic approach for fetal transesophageal electrocardiography and stimulation aimed at diagnosis and termination of these tachycardias. METHODS AND RESULTS: We studied a total of 10 fetal sheep (87 to 103 days of gestation; term=145 days). We entered the amniotic cavity using a percutaneous fetoscopic approach and placed various electrophysiology catheters into the fetal esophagus. We recorded the number of animals in which fetoscopic transesophageal electrocardiography and stimulation were successful and assessed pacing success and thresholds for different catheters. In addition, we monitored for potential adverse effects from stimulation and for other complications of the operation. Recording of transesophageal electrocardiograms was successful in all fetal sheep. Capture during stimulation was successfully documented by additional fetal bipolar surface electrocardiograms in 7 fetuses. In fetuses in which fetal surface electrocardiograms were not recorded, pacing stimulus artifacts interfered with documentation of capture. Although stimulation thresholds were high, the maternal rhythm was not affected by fetal stimulation. CONCLUSIONS: Fetoscopic fetal transesophageal electrocardiography and stimulation are feasible in fetal sheep. This minimally invasive approach might have the potential to improve diagnosis and management of therapy-refractory supraventricular tachycardias in human fetuses.
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Kohl et al. (1999) studied Therapy-refractory supraventricular tachycardia (model) (n=10). Fetoscopic transesophageal electrocardiography and stimulation was evaluated on Successful recording of transesophageal electrocardiograms and pacing capture. Fetoscopic transesophageal electrocardiography was successfully recorded in 100% of fetal sheep (10/10), with pacing capture documented in 7 fetuses, demonstrating procedural feasibility.
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