Intrauterine Pediatrics

Follow-up analysis of 13 fetuses with complete atrioventricular conduction block

  • Jing’e OUYANG ,
  • Huiyu MIAO ,
  • Lianghua QIU ,
  • Zaiyu WANG ,
  • Fengling YE ,
  • Lili LIN ,
  • Jiejian CHEN
Expand
  • 1. Department of Cardiology, 900Th Hospital of Joint Logistics Support Force, PLA, Fuzhou 350025, Fujian, China
    2. Department of Nephrology, 900Th Hospital of Joint Logistics Support Force, PLA, Fuzhou 350025, Fujian, China

Received date: 2022-08-22

  Online published: 2023-02-16

Abstract

Objective To explore the clinical characteristics and prognosis of fetuses with complete atrioventricular conduction block (CAVB). Methods The clinical characteristics, treatment and outcome of 13 fetal CAVB patients diagnosed by the 900TH Hospital of Joint Logistics Support Force from January 2012 to August 2022 were retrospectively analyzed. Results A total of 13 CAVB fetuses were included, of whom 7 were terminated and 6 survived. Among the 7 terminated fetuses, 6 were complicated with decreased cardiac function, 5 had cardiac structural abnormalities, and mothers of 4 fetuses were positive for ANA and SSA antibodies. Among the 6 surviving fetuses, 1 case was complicated with decreased cardiac function, 2 cases had cardiac structural abnormalities, and mothers of 5 cases were positive for ANA and SSA antibodies. One child had a resting ventricular rate of 42-45 beats/min after birth. He was implanted with a permanent pacemaker because of sudden syncope at the age of 5 years. One patient had atrial septal defect with ventricular rate <70 beats /min. He underwent atrial septal defect repair without pacemaker implantation at the age of 2 years. The remaining 4 patients had ventricular rate >52 beats /min without pacemaker implantation.Conclusion If the CAVB fetus with normal cardiac function and normal cardiac structure has no obvious symptoms after birth, most of them have a good prognosis and permanent pacemaker implantation can be deferred.

Cite this article

Jing’e OUYANG , Huiyu MIAO , Lianghua QIU , Zaiyu WANG , Fengling YE , Lili LIN , Jiejian CHEN . Follow-up analysis of 13 fetuses with complete atrioventricular conduction block[J]. Journal of Clinical Pediatrics, 2023 , 41(1) : 30 -33 . DOI: 10.12372/jcp.2023.22e1143

References

[1] Manolis AA, Manolis TA, Melita H, et al. Congenital heart block: Pace earlier (Childhood) than later (Adulthood)[J]. Trends Cardiovasc Med, 2020, 30(5): 275-286.
[2] Larmay HJ, Strasburger JF. Differential diagnosis and management of the fetus and newborn with an irregular or abnormal heart rate[J]. Pediatr Clin North Am, 2004, 51(4): 1033-1050.
[3] Hansahiranwadee W. Diagnosis and management of fetal autoimmune atrioventricular block[J]. Int J Womens Health, 2020, 12: 633-639.
[4] Steinberg L. Congenital Heart Block[J]. Card Electrophysiol Clin, 2021, 13(4): 691-702.
[5] Eliasson H, Sonesson SE, Sharland G, et al. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients[J]. Circulation, 2011, 124(18): 1919-1926.
[6] Izmirly PM, Saxena A, Kim MY, et al. Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus[J]. Circulation, 2011, 124(18): 1927-1935.
[7] Kuleva M, Le Bidois J, Decaudin A, et al. Clinical course and outcome of antenatally detected atrioventricular block: experience of a single tertiary centre and review of the literature[J]. Prenat Diagn, 2015, 35(4): 354-361.
[8] Escobar-Diaz MC, Tworetzky W, Friedman K, et al. Perinatal outcome in fetuses with heterotaxy syndrome and atrioventricular block or bradycardia[J]. Pediatr Cardiol, 2014, 35(6): 906-913.
[9] Jaeggi ET, Hornberger LK, Smallhorn JF, et al. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature[J]. Ultrasound Obstet Gynecol, 2005, 26(1): 16-21.
[10] Hernstadt H, Regan W, Bhatt H, et al. Cohort study of congenital complete heart block among preterm neonates: a single-center experience over a 15-year period[J]. Eur J Pediatr, 2022, 181(3): 1047-1054.
[11] Ruffatti A, Cerutti A, Tonello M, et al. Short and long-term outcomes of children with autoimmune congenital heart block treated with a combined maternal-neonatal therapy. A comparison study[J]. J Perinatol, 2022, 42(9): 1161-1168.
[12] Saito M, Silverman E, Golding F, et al. Effects of transplacental dexamethasone therapy on fetal immune-mediated complete heart block[J]. Fetal Diagn Ther, 2021, 48(3): 183-188.
[13] De Carolis S, Garufi C, Garufi E, et al. Autoimmune congenital heart block: a review of biomarkers and management of pregnancy[J]. Front Pediatr, 2020, 8: 607515.
[14] Izmirly PM, Saxena A, Sahl SK, et al. Assessment of fluorinated steroids to avert progression and mortality in anti-SSA/Ro-associated cardiac injury limited to the fetal conduction system[J]. Ann Rheum Dis, 2016, 75(6): 1161-1165.
[15] Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2013, 61(3): e6-75.
[16] Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society[J]. Heart Rhythm, 2019, 74(7): e51-e156.
[17] Jaeggi ET, Hamilton RM, Silverman ED, et al. Outcome of children with fetal, neonatal or childhood diagnosis of isolated congenital atrioventricular block. A single institution's experience of 30 years[J]. J Am Coll Cardiol, 2002, 39(1): 130-1387.
[18] Micha?lsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study[J]. Circulation, 1995, 92(3): 442-449.
Outlines

/