title: Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses.
abstract: OBJECTIVE
  We prospectively examined the prevalence and outcome of untreated fetal atrioventricular (AV) prolongation in the presence of maternal anti-Ro antibodies.
  
  
  BACKGROUND
  It has been suggested that antibody-mediated congenital complete atrioventricular block (CAVB) may be preventable if detected and treated early when low-grade block is present. With this rationale in mind, dexamethasone has been advocated by others to treat prolonged fetal AV conduction >2 z-scores, consistent with first-degree heart block.
  
  
  METHODS
  Between July 2003 and June 2009, 165 fetuses of 142 anti-Ro/La antibody-positive women were referred to our center for serial echocardiography. Our protocol included weekly evaluation of the fetal AV conduction between 19 (range 17 to 23) and 24 (range 23 to 35) gestational weeks. AV times were compared with institutional reference data and with post-natal electrocardiograms.
  
  
  RESULTS
  Of 150 fetuses with persistently normal AV conduction throughout the observation period, a diagnosis of CAVB was subsequently made in 1 at 28 weeks, after the serial evaluation had ended. Of 15 untreated fetuses either with AV prolongation between 2 and 6 z-scores or with type 1 second-degree block, progressive heart block developed in none of them. Three of these 15 fetuses (20%) had a neonatal diagnosis of first-degree block that spontaneously resolved (n = 2) or has not progressed (n = 1) on follow-up examinations. No other cardiac complications were detected.
  
  
  CONCLUSIONS
  Fetal AV prolongation did not predict progressive heart block to birth. Our findings question the rationale of a management strategy that relies on the early identification and treatment of fetal AV prolongation to prevent CAVB.
authors: Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada. edgar.jaeggi@sickkids.ca
authors: Edgar T
authors: ET
authors: Jaeggi
authors: Earl D
authors: ED
authors: Silverman
authors: Carl
authors: C
authors: Laskin
authors: John
authors: J
authors: Kingdom
authors: Fraser
authors: F
authors: Golding
authors: Roland
authors: R
authors: Weber
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood*; D054537:Atrioventricular Block / Q000151:congenital / Q000175:diagnosis* / Q000276:immunology; D001283:Atrioventricular Node / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018617:Ultrasonography, Doppler, Pulsed
chemical_list: D000974:Antibodies, Antinuclear