Head orientation and electrode placement potentially influence fetal scalp ECG waveform

Alexandra D.J. Hulsenboom, Guy J.J. Warmerdam, Janna Weijers, Paul J. Blijham, S. Guid Oei, Judith O.E.H. van Laar, Rik Vullings, Tammo Delhaas (Corresponding author)

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

Uittreksel

Background Fetal monitoring based on electrocardiographic (ECG) morphology is obtained from a single unipolar fetal scalp electrode. Ideally, it should be obtained from multiple leads, as ECG waveform depends on alignment between electrode and electrical heart axis. This alignment is unknown in fetuses. Besides, fetuses are surrounded by conductive media, which may influence ECG waveform. We explored the influence of electrode position and head orientation on ECG waveforms of unipolar and bipolar scalp ECGs recorded in air and in conductive medium. Methods We recorded ECGs in one adult subject at five different scalp positions in five different head orientations both in dry and immersed conditions. The ratio between T-amplitude and QRS-amplitude (T/QRS ratio) of unipolar and bipolar scalp ECGs was determined and compared between all conditions. Results In the dry condition, we observed in the unipolar leads little to no difference between different electrode positions (maximal T/QRS difference 0.00–0.01) and minor differences between head orientations (0.02–0.03), whereas bipolar leads showed no recognizable ECG signal at all. During the immersed condition, we found variation in the unipolar leads, both between electrode positions (maximal T/QRS difference 0.02–0.05) and between head orientations (0.03–0.06). Bipolar leads showed different ECG signals in contrasting head orientations. Conclusions Both unipolar and bipolar scalp lead-derived ECG waveforms are influenced by electrode position and head orientation when the subject is submerged in a conductive medium. Fetal monitoring based on single scalp lead ECG waveform might be suboptimal, as it lacks correction for fetal head orientation and electrode position.

TaalEngels
Artikelnummere0223282
Aantal pagina's9
TijdschriftPLoS ONE
Volume14
Nummer van het tijdschrift10
DOI's
StatusGepubliceerd - 10 okt 2019

Vingerafdruk

Scalp
electrodes
Electrodes
Head
Fetal monitoring
Electrocardiography
Fetal Monitoring
fetus
Fetus
monitoring
heart
Air
air

Citeer dit

Hulsenboom, Alexandra D.J. ; Warmerdam, Guy J.J. ; Weijers, Janna ; Blijham, Paul J. ; Guid Oei, S. ; van Laar, Judith O.E.H. ; Vullings, Rik ; Delhaas, Tammo. / Head orientation and electrode placement potentially influence fetal scalp ECG waveform. In: PLoS ONE. 2019 ; Vol. 14, Nr. 10.
@article{4e41f42132fe4f24b15185f97b2e5dea,
title = "Head orientation and electrode placement potentially influence fetal scalp ECG waveform",
abstract = "Background Fetal monitoring based on electrocardiographic (ECG) morphology is obtained from a single unipolar fetal scalp electrode. Ideally, it should be obtained from multiple leads, as ECG waveform depends on alignment between electrode and electrical heart axis. This alignment is unknown in fetuses. Besides, fetuses are surrounded by conductive media, which may influence ECG waveform. We explored the influence of electrode position and head orientation on ECG waveforms of unipolar and bipolar scalp ECGs recorded in air and in conductive medium. Methods We recorded ECGs in one adult subject at five different scalp positions in five different head orientations both in dry and immersed conditions. The ratio between T-amplitude and QRS-amplitude (T/QRS ratio) of unipolar and bipolar scalp ECGs was determined and compared between all conditions. Results In the dry condition, we observed in the unipolar leads little to no difference between different electrode positions (maximal T/QRS difference 0.00–0.01) and minor differences between head orientations (0.02–0.03), whereas bipolar leads showed no recognizable ECG signal at all. During the immersed condition, we found variation in the unipolar leads, both between electrode positions (maximal T/QRS difference 0.02–0.05) and between head orientations (0.03–0.06). Bipolar leads showed different ECG signals in contrasting head orientations. Conclusions Both unipolar and bipolar scalp lead-derived ECG waveforms are influenced by electrode position and head orientation when the subject is submerged in a conductive medium. Fetal monitoring based on single scalp lead ECG waveform might be suboptimal, as it lacks correction for fetal head orientation and electrode position.",
author = "Hulsenboom, {Alexandra D.J.} and Warmerdam, {Guy J.J.} and Janna Weijers and Blijham, {Paul J.} and {Guid Oei}, S. and {van Laar}, {Judith O.E.H.} and Rik Vullings and Tammo Delhaas",
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Head orientation and electrode placement potentially influence fetal scalp ECG waveform. / Hulsenboom, Alexandra D.J.; Warmerdam, Guy J.J.; Weijers, Janna; Blijham, Paul J.; Guid Oei, S.; van Laar, Judith O.E.H.; Vullings, Rik; Delhaas, Tammo (Corresponding author).

In: PLoS ONE, Vol. 14, Nr. 10, e0223282, 10.10.2019.

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

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AU - Hulsenboom,Alexandra D.J.

AU - Warmerdam,Guy J.J.

AU - Weijers,Janna

AU - Blijham,Paul J.

AU - Guid Oei,S.

AU - van Laar,Judith O.E.H.

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AU - Delhaas,Tammo

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N2 - Background Fetal monitoring based on electrocardiographic (ECG) morphology is obtained from a single unipolar fetal scalp electrode. Ideally, it should be obtained from multiple leads, as ECG waveform depends on alignment between electrode and electrical heart axis. This alignment is unknown in fetuses. Besides, fetuses are surrounded by conductive media, which may influence ECG waveform. We explored the influence of electrode position and head orientation on ECG waveforms of unipolar and bipolar scalp ECGs recorded in air and in conductive medium. Methods We recorded ECGs in one adult subject at five different scalp positions in five different head orientations both in dry and immersed conditions. The ratio between T-amplitude and QRS-amplitude (T/QRS ratio) of unipolar and bipolar scalp ECGs was determined and compared between all conditions. Results In the dry condition, we observed in the unipolar leads little to no difference between different electrode positions (maximal T/QRS difference 0.00–0.01) and minor differences between head orientations (0.02–0.03), whereas bipolar leads showed no recognizable ECG signal at all. During the immersed condition, we found variation in the unipolar leads, both between electrode positions (maximal T/QRS difference 0.02–0.05) and between head orientations (0.03–0.06). Bipolar leads showed different ECG signals in contrasting head orientations. Conclusions Both unipolar and bipolar scalp lead-derived ECG waveforms are influenced by electrode position and head orientation when the subject is submerged in a conductive medium. Fetal monitoring based on single scalp lead ECG waveform might be suboptimal, as it lacks correction for fetal head orientation and electrode position.

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Hulsenboom ADJ, Warmerdam GJJ, Weijers J, Blijham PJ, Guid Oei S, van Laar JOEH et al. Head orientation and electrode placement potentially influence fetal scalp ECG waveform. PLoS ONE. 2019 okt 10;14(10). e0223282. Beschikbaar vanaf, DOI: 10.1371/journal.pone.0223282