Controversies in the Management of Isolated Congenital Atrioventricular Block.

Abstract

Congenital atrioventricular block (CAVB) affects approximately 2% of fetuses of mothers with anti-Ro or anti-La antibodies, regardless of maternal rheumatologic symptoms. Anti-Ro and anti-La antibodies are antinuclear antibodies commonly found in autoimmune diseases. Congenital atrioventricular block is associated with a relatively high fetal morbidity and mortality, particularly more advanced degrees of block. There is significant controversy surrounding surveillance of anti-Ro/La-positive pregnancies and treatment of fetuses diagnosed with CAVB. Studies of dexamethasone in the treatment of CAVB have yielded conflicting results, with most suggesting only a limited potential benefit in first- and seconddegree CAVB and in cases complicated by fetal hydrops. Larger prospective studies are needed to further evaluate the efficacy of intravenous immunoglobulin in the treatment of CAVB and of intravenous immunoglobulin and hydroxychloroquine in the prevention of CAVB in fetuses of at-risk mothers. Surveillance and treatment regimens should be determined on a case-by-case basis, taking into consideration the degree of CAVB, costs, and potential adverse effects of treatment.

• Authors: Anna E DeNoble, Jeffrey A Kuller, Eleanor J Rhee
• Journal: Obstetrical & gynecological survey (Obstet Gynecol Surv) Vol. 70 Issue 8 Pg. 518-23 (Aug 2015) ISSN: 1533-9866 [Electronic] United States
• PMID: 26314237 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Inflammatory Agents
• Antirheumatic Agents
• Immunoglobulins
• Immunologic Factors
• Hydroxychloroquine
• Dexamethasone

Topics

• Anti-Inflammatory Agents (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Atrioventricular Block (congenital, drug therapy, immunology)
• Dexamethasone (therapeutic use)
• Female
• Histocompatibility, Maternal-Fetal (immunology)
• Humans
• Hydroxychloroquine (therapeutic use)
• Immunoglobulins (therapeutic use)
• Immunologic Factors (therapeutic use)
• Infant, Newborn
• Pregnancy
• Prenatal Diagnosis