Importance of Fetal Arrhythmias to the Neonatologist and Pediatrician

Fetal Arrhythmia Detection Based on Labeling Considering Heartbeat Interval

Arrhythmia is one of the causes of sudden infant death, and it is very important to detect fetal arrhythmia for fetal well-being. Fetal electrocardiogram (FECG) is one of the methods to detect a heartbeat. Fetal arrhythmia can be detected based on the heartbeat detection results from FECG signals such as heartbeat intervals. However, the accuracy of arrhythmia detection easily degrades depending on the accuracy of heartbeat detection. In this paper, we propose a deep learning-based fetal arrhythmia detection method using FECG signals. Recently, arrhythmia detection methods using adult ECG signals have achieved a high arrhythmia detection accuracy based on deep learning. Motivated by this fact, in the proposed method, the acquired FECG signals are segmented, and the segments are input into a deep learning model that classifies them into normal or arrhythmia ones. Based on the classification results of multiple segments, a subject is judged as a healthy or arrhythmia subject. Each segment of the training data is divided into three categories based on the estimated heartbeat interval: (i) normal, (ii) arrhythmia, and (iii) a segment that could be both normal and arrhythmic. Only segments labeled as normal or arrhythmia are used for training a deep learning model to achieve a higher classification accuracy of the model. Through these procedures, the proposed method detects fetal arrhythmia with fewer effects of heartbeat detection results. The experimental results show that the proposed method achieves 96.2% accuracy, 100% specificity, and 100% recall, improving the values of conventional methods based on heartbeat detection and feature detection.

Fetal Bradycardia Caused by Monogenic Disorders-A Review of the Literature

Introduction: The standard obstetric definition of fetal bradycardia is a sustained fetal heart rate < 110 bpm over at least 10 min. Fetal bradycardia can be the first and only prenatal presentation of a heart disease. We present an overview on different genetic disorders that should be taken into consideration in case of diagnosed fetal bradycardia. Methods: A literature review was conducted using a PubMed- and OMIM-based search for monogenetic disorders causing fetal bradycardia in September 2022. Results: The review on the literature identified nine monogenic diseases that could lead to fetal bradycardia. Four of these disorders can be associated with extracardiac findings. Discussion: Genetic testing should be considered in cases with fetal bradycardia, especially in cases of additional extracardiac findings. Broad sequencing techniques and improved prenatal phenotyping could help to establish a diagnosis in an increasing number of cases.

Contribution of Fetal Magnetocardiography to Diagnosis, Risk Assessment, and Treatment of Fetal Arrhythmia

Background

Fetal echocardiography has been the mainstay of fetal arrhythmia diagnosis; however, fetal magnetocardiography (fMCG) has recently become clinically available. We sought to determine to what extent fMCG contributed to the precision and accuracy of fetal arrhythmia diagnosis and risk assessment, and in turn, how this altered pregnancy management.

Methods and Results

We reviewed fMCG tracings and medical records of 215 pregnancies referred to the Biomagnetism Laboratory, UW‐Madison, over the last 10 years, because of fetal arrhythmia or risk of arrhythmia. We compared referral diagnosis and treatment with fMCG diagnosis using a rating scale and restricted our review to the 144 subjects from the tachycardia, bradycardia/AV block, and familial long QT syndrome categories. Additional fMCG findings beyond those of the referring echocardiogram, or an alternative diagnosis were seen in 117/144 (81%), and 81 (56%) were critical changes. Eight (5.5%) had resolution of arrhythmia before fMCG. At least moderate changes in management were seen in 109/144 (76%) fetuses, of which 35/144 (24%) were major. The most diverse fMCG presentation was long QT syndrome, present in all 3 referral categories. Four of 5 stillbirths were seen with long QT syndrome. Nine fetuses showed torsades de pointes ventricular tachycardia, of which only 2 were recognized before fMCG.

Conclusions

FMCG has a significant impact on prenatal diagnosis and management of arrhythmias or familial arrhythmia risk, which cannot be fully met by existing technology. The combination of fMCG and fetal echocardiography in fetal care centers will be needed in the future to optimize care.