Head orientation and electrode placement potentially influence fetal scalp ECG waveform
Autoři:
Alexandra D. J. Hulsenboom aff001; Guy J. J. Warmerdam aff002; Janna Weijers aff001; Paul J. Blijham aff003; S. Guid Oei aff001; Judith O. E. H. van Laar aff001; Rik Vullings aff002; Tammo Delhaas aff004
Působiště autorů:
Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, the Netherlands
aff001; Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
aff002; Department of Clinical Neurophysiology, Máxima Medical Center, Veldhoven, the Netherlands
aff003; Department of BioMedical Engineering, Maastricht University Medical Center, Maastricht, the Netherlands
aff004
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0223282
Souhrn
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.
Klíčová slova:
Head – Electrocardiography – Electric conductivity – Scalp – Electrode potentials – Electrode recording – Fetuses
Zdroje
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