Rheumatology Medical News about Heart, Lupus, Atrioventricular

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Prevention of complete heart block in children of mothers with anti-SSA/Ro and anti-SSB/La autoantibodies: Detection and treatment of first-degree atrioventricular block
Current Opinion in Rheumatology, 08/18/09

Mevorach D et al. – Study reports that Echo Doppler is a reliable method for early detection of fetus first-degree atrioventricular blocks (AVB); fetal kinetocardiogram or fetal electrocardiography are preferred. Immediate treatment with fluorinated steroids for first-degree AVB is recommended due to the high risk of rapid progression to complete blockage.

Methods

Article describes the results of 2 recent prospective studies including:
- How to monitor, diagnose, and treat fetuses with neonatal lupus manifesting with heart involvement, and
- Summarize additional research reports regarding the pathophysiology and outcomes of this rare condition

Results

PR Interval and Dexamethasone Evaluation study:
- 10 cases of neonatal lupus (10%) with 3 first-degree AVBs and 3 complete heart blocks
- 98 pregnancies in 95 women with anti-SSA/Ro Abs who completed weekly fetal Doppler echocardiogram-based evaluation
- First-degree AVB could not be detected before progression to complete heart block
A similar observational prospective study performed in:
- 70 fetuses of 56 mothers using tissue velocity fetal kinetocardiogram for measurement of PR prolongation
- 6 fetuses (8.5%) showed first-degree AVB
- Fast normalization of heart function was achieved through maternal treatment with fluorinated steroids
These studies cncluded that :
- Fetal kinetocardiogram can detect first-degree AVB in the fetus exposed to maternal anti-SSA/Ro or anti-SSB/La Abs or both, and
- Fluorinated steroids given on detection were associated with normalized atrioventricular conduction in fetuses with first-degree AVB