TY - JOUR
T1 - Isolated atrioventricular block in the fetus
T2 - A retrospective, multinational, multicenter study of 175 patients
AU - the Fetal Working Group of the AEPC
AU - Eliasson, Håkan
AU - Sonesson, Sven Erik
AU - Sharland, Gurleen
AU - Granath, Fredrik
AU - Simpson, John M.
AU - Carvalho, Julene S.
AU - Jicinska, Hana
AU - Tomek, Viktor
AU - Dangel, Joanna
AU - Zielinsky, Paulo
AU - Respondek-Liberska, Maria
AU - Freund, Matthias W.
AU - Mellander, Mats
AU - Bartrons, Joaquim
AU - Gardiner, Helena M.
AU - Study group members AMC, null
AU - Clur, Sally Ann b B.
PY - 2011/11/1
Y1 - 2011/11/1
N2 - BACKGROUND: Isolated complete atrioventricular block in the fetus is a rare but potentially lethal condition in which the effect of steroid treatment on outcome is unclear. The objective of this work was to study risk factors associated with death and the influence of steroid treatment on outcome. METHODS AND RESULTS-: We studied 175 fetuses diagnosed with second- or third-degree atrioventricular block (2000-2007) retrospectively in a multinational, multicenter setting. In 80% of 162 pregnancies with documented antibody status, atrioventricular block was associated with maternal anti-Ro/SSA antibodies. Sixty-seven cases (38%) were treated with fluorinated corticosteroids for a median of 10 weeks (1-21 weeks). Ninety-one percent were alive at birth, and survival in the neonatal period was 93%, similar in steroid-treated and untreated fetuses, regardless of degree of block and/or presence of anti-Ro/SSA. Variables associated with death were gestational age <20 weeks, ventricular rate ≤50 bpm, fetal hydrops, and impaired left ventricular function at diagnosis. The presence of ≥1 of these variables was associated with a 10-fold increase in mortality before birth and a 6-fold increase in the neonatal period independently of treatment. Except for a lower gestational age at diagnosis in treated than untreated (23.4±2.9 versus 24.9±4.9 weeks; P=0.02), risk factors were distributed equally between treatment groups. Two-thirds of survivors had a pacemaker by 1 year of age; 8 children developed cardiomyopathy. CONCLUSIONS-: Risk factors associated with a poor outcome were gestation <20 weeks, ventricular rate ≤50 bpm, hydrops, and impaired left ventricular function. No significant effect of treatment with fluorinated corticosteroids was seen.
AB - BACKGROUND: Isolated complete atrioventricular block in the fetus is a rare but potentially lethal condition in which the effect of steroid treatment on outcome is unclear. The objective of this work was to study risk factors associated with death and the influence of steroid treatment on outcome. METHODS AND RESULTS-: We studied 175 fetuses diagnosed with second- or third-degree atrioventricular block (2000-2007) retrospectively in a multinational, multicenter setting. In 80% of 162 pregnancies with documented antibody status, atrioventricular block was associated with maternal anti-Ro/SSA antibodies. Sixty-seven cases (38%) were treated with fluorinated corticosteroids for a median of 10 weeks (1-21 weeks). Ninety-one percent were alive at birth, and survival in the neonatal period was 93%, similar in steroid-treated and untreated fetuses, regardless of degree of block and/or presence of anti-Ro/SSA. Variables associated with death were gestational age <20 weeks, ventricular rate ≤50 bpm, fetal hydrops, and impaired left ventricular function at diagnosis. The presence of ≥1 of these variables was associated with a 10-fold increase in mortality before birth and a 6-fold increase in the neonatal period independently of treatment. Except for a lower gestational age at diagnosis in treated than untreated (23.4±2.9 versus 24.9±4.9 weeks; P=0.02), risk factors were distributed equally between treatment groups. Two-thirds of survivors had a pacemaker by 1 year of age; 8 children developed cardiomyopathy. CONCLUSIONS-: Risk factors associated with a poor outcome were gestation <20 weeks, ventricular rate ≤50 bpm, hydrops, and impaired left ventricular function. No significant effect of treatment with fluorinated corticosteroids was seen.
KW - atrioventricular block
KW - fetal heart
KW - lupus erythematosus
KW - systemic
KW - therapeutic
UR - http://www.scopus.com/inward/record.url?scp=80155155860&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/CIRCULATIONAHA.111.041970
DO - https://doi.org/10.1161/CIRCULATIONAHA.111.041970
M3 - Article
C2 - 21986286
SN - 0009-7322
VL - 124
SP - 1919
EP - 1926
JO - Circulation
JF - Circulation
IS - 18
ER -