title: 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.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Pediatric Cardiology, University of Münster Medical School, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kohl
authors.forename: P F
authors.initials: PF
authors.lastname: Kirchhof
authors.forename: W
authors.initials: W
authors.lastname: Gogarten
authors.forename: J
authors.initials: J
authors.lastname: Reckers
authors.forename: B
authors.initials: B
authors.lastname: Asfour
authors.forename: R
authors.initials: R
authors.lastname: Witteler
authors.forename: W
authors.initials: W
authors.lastname: Haverkamp
authors.forename: L
authors.initials: L
authors.lastname: Eckardt
authors.forename: A E
authors.initials: AE
authors.lastname: Marcus
authors.forename: H
authors.initials: H
authors.lastname: VanAken
authors.forename: G
authors.initials: G
authors.lastname: Breithardt
authors.forename: J
authors.initials: J
authors.lastname: Vogt
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004558:Electric Stimulation; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005332:Fetoscopy; D012756:Sheep / Q000196:embryology; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging* / Q000196:embryology / Q000628:therapy