A systematic review of prenatal screening for congenital heart disease by fetal electrocardiography

Abstract

Background: Congenital heart disease (CHD) is the most common severe congenital anomaly worldwide. Diagnosis early in pregnancy is important, but the detection rate by two-dimensional ultrasonography is only 65%-81%.

Objectives: To evaluate existing data on CHD and noninvasive abdominal fetal electrocardiography (ECG).

Search strategy: A systematic review was performed through a search of the Cochrane Library, PubMed, and Embase for studies published up to April 2016 using the terms "congenital heart disease," "fetal electrocardiogram," and other similar keywords.

Selection criteria: Primary articles that described changes in fetal ECG among fetuses with CHD published in English were included.

Data collection and analysis: Outcomes of interest were changes in fetal ECG parameters observed for fetuses with congenital heart disease. Findings were reported descriptively.

Main results: Only five studies described changes observed in the fetal electrocardiogram for fetuses with CHD, including heart rate, heart rate variability, and PR, QRS, and QT intervals. Fetal ECG reflects the intimate relationship between the cardiac nerve conduction system and the structural morphology of the heart. It seems particularly helpful in detecting the electrophysiological effects of cardiac anatomic defects (e.g. hypotrophy, hypertrophy, and conduction interruption).

Conclusions: Fetal ECG might be a promising clinical tool to complement ultrasonography in the screening program for CHD.

Keywords: Congenital heart disease; Fetal electrocardiogram; Fetal electrocardiography; Prenatal diagnosis; Prenatal screening.