The effectiveness of transplacental
drug therapy for prenatally diagnosed isolated congenital complete
atrioventricular block (CCAVB) is controversial. Nine cases of prenatal isolated CCAVB were treated from 2002 to 2007.
Ritodrine was administered transplacentally to all fetuses and
betamethasone to those whose mothers tested positive for maternal anti-SSA/
Ro antibodies. Six of the nine patients had an anti-SSA/Ro-positive mother and received transplacental
betamethasone 4 mg/day at a median gestational age of 28 weeks (range, 24-31 weeks). No patients exhibited an improvement in the degrees of complete
heart block, and one patient died in utero. No serious adverse events occurred. After the mean follow-up period of 1.7 +/- 1.3 years, all five patients treated with transplacental
betamethasone experienced a good cardiac function, whereas one of the three patients not treated with transplacental
betamethasone experienced
cardiomyopathy and died at the age of 4 months. Pacemaker implantation was required for seven of the eight live-born infants. Transplacental
betamethasone therapy for the patients with isolated CCAVB neither improved the degree of
atrioventricular block nor decreased the rate of patients requiring pacemaker implantation, but it probably reduced the risk for the development of
myocardial disease.