Immune-Mediated Fetal Complete Atrioventricular Block: Can Dexamethasone Therapy Revert the Process?

Fetal complete atrioventricular block (CAVB) is usually autoimmune mediated. The risk of developing CAVB is 2% to 3% in anti-Ro/SS-A seropositive pregnancies and it increases 10 times after previous CAVB in siblings. Despite being a rare complication, CAVB carries a 20% mortality rate and substantia...

Full description

Saved in:
Bibliographic Details
Published in:The Israel Medical Association journal 2020-11, Vol.11 (22), p.711-716
Main Authors: Perles, Zeev, Ishay, Yuval, Nir, Amiram, Gavri, Sagui, Golender, Julius, Ta-Shma, Asaf, Abu-Zahira, Ibrahim, Natsheh, Juma, Elchalal, Uriel, Mevorach, Dror, Rein, Azaria Jjt
Format: Article
Language:English
Subjects:
Adult
Atrioventricular Block - diagnosis
Atrioventricular Block - drug therapy
Atrioventricular Block - immunology
Dexamethasone - administration & dosage
Female
Fetal Diseases - diagnosis
Fetal Diseases - drug therapy
Fetal Diseases - immunology
Glucocorticoids - administration & dosage
Humans
Infant, Newborn
Pregnancy
Pregnancy Trimester, Second
Prenatal Diagnosis - methods
Treatment Outcome
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Fetal complete atrioventricular block (CAVB) is usually autoimmune mediated. The risk of developing CAVB is 2% to 3% in anti-Ro/SS-A seropositive pregnancies and it increases 10 times after previous CAVB in siblings. Despite being a rare complication, CAVB carries a 20% mortality rate and substantial morbidity, as about 65% of newborns will eventually need life-long pacing. Once found, fetal CAVB is almost always irreversible, despite aggressive immunotherapy. This poor outcome prompted some research groups to address this situation. All groups followed anti-Ro/SS-A seropositive pregnancies on a weekly basis during the second trimester of pregnancy and tried to detect first degree atrioventricular block (AVB) using accurate echocardiographic tools, assuming they may characterize the initiation of the immune damage to the A-V conduction system, at which point the process might still be reversible. Some of the groups treated fetuses with first degree AVB with maternal oral fluorinated steroids. We summarized the results of all groups, including our group. We describe a case of a fetus that developed CAVB 6 days after normal sinus rhythm (NSR), who under aggressive dexamethasone therapy gradually reverted to NSR. This fetus had a previous sibling with CAVB. We assumed the immune damage to the conduction system in this small group of fetuses with a previous CAVB sibling may have occurred more quickly than usual. We therefore recommend a twice-weekly follow-up with these fetuses.
ISSN:1565-1088