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(Circulation. 1999;100:772-776.)
© 1999 American Heart Association, Inc.

Basic Science Reports

Fetoscopic Transesophageal Electrocardiography and Stimulation in Fetal Sheep

A Minimally Invasive Approach Aimed at Diagnosis and Termination of Therapy-Refractory Supraventricular Tachycardias in Human Fetuses

Thomas Kohl, MD; Paulus F. Kirchhof, MD; Wiebke Gogarten, MD; Julia Reckers, MS; Boulos Asfour, MD; Ralf Witteler, MD; Wilhelm Haverkamp, MD; Lars Eckardt, MD; Abraham E. Marcus, MD; Hugo VanAken, MD; Günter Breithardt, MD; Johannes Vogt, MD; Hans H. Scheld, MD

From the Departments of Pediatric Cardiology (T.K., J.R., J.V.), Cardiothoracic Surgery (T.K., B.A., H.H.S.), Cardiology and Angiology (P.F.K., W.H., L.E., G.B.), Anesthesia (W.G., A.E.M., H.V.), and Obstetrics (R.W.), University of Münster Medical School, Germany.

Correspondence to Thomas Kohl, MD, Departments of Pediatric Cardiology and Cardiothoracic Surgery, University of Münster Medical School, Albert Schweitzer Str 33, 48149 Münster, Germany. E-mail tkohl{at}muenster.de

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.

Key Words: tachycardia • electrocardiography • electrophysiology • fetoscopy

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