Fluorinated steroids do not improve outcome of isolated atrioventricular block

Berg, Nicoline W. E. van den; Slieker, Martijn G.; Beynum, Ingrid M. van; Bilardo, C. M.; Bruijn, Diederik de; Clur, S. A.; Cornette, Jérôme; Frohn-Mulder, Ingrid M.E.; Haak, Monique C.; Loo-Maurus, Kristien E. H. van; Manten, G. T. R.; Rackowitz, Annette; Rammeloo, Lukas A. J.; Reimer, Annette; Rijlaarsdam, María; Freund, Matthias W.

doi:10.1016/j.ijcard.2016.09.119

Cited by 36 publications

(22 citation statements)

References 28 publications

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“…Fetal complications were defined according to common definitions (10–13). Atrioventricular block (AVB)-II° was defined as the intermittent mechanical dissociation of atrial and ventricular activation diagnosed by M-mode echocardiography and AVB-III° as the complete mechanical dissociation of atrial and ventricular activation diagnosed by M-mode (10, 13).…”

Section: Methodsmentioning

confidence: 99%

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First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry)

Fredi

Andréoli

Bacco

et al. 2019

Front. Cardiovasc. Med.

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Objective: Neonatal Lupus (NL) is a rare syndrome caused by placental transfer of maternal anti-SSA/Ro and anti-La/SSB autoantibodies to the fetus. The rarity of this condition requires the establishment of multidisciplinary registries in order to improve our knowledge. Method: Inclusion criteria in this retrospective study were the maternal confirmed positivity for anti-SSA/Ro and/or anti-SSB/La antibodies, and the presence of II or III degree congenital heart block (CHB) in utero or neonatal period (up to 27 days after birth). Result: Eighty-nine cases of CHB were observed in 85 women with 88 pregnancies that occurred between 1969 and 2017. CHB was mostly detected in utero (84 cases, 94.2%), while five cases were observed in the neonatal period. A permanent pacemaker was implanted in 51 of 73 children born alive (69.8), whereas global mortality rate was 25.8% (23 cases): 16 in utero , five perinatal, and two during childhood. By univariate analysis, factors associated with fetal death were pleural effusion ( p = 0.005, OR > 100; CI 95% 2.88->100 and hydrops ( p = 0.003, OR = 14.09; CI 95% 2.01–122). Fluorinated steroids (FS) were administered in 71.4% pregnancies, and its use was not associated with better survival. Some centers treated all cases with fluorinated steroids and some centers did not treat any case. CHB was initially incomplete in 24 fetuses, and of them five cases of II degree block reverted to a lower degree block after treatments. Recurrence rate in subsequent pregnancies was 17.6% (3 out of 17). A prophylactic treatment was introduced in 10 of these 16 subsequent (58.8%) pregnancies, mostly with FS or high dose intravenous immunoglobulins. Conclusion: This is the first report from the Italian Registry of neonatal lupus/CHB. The live birth rate was nearly 80%, with nearly two thirds of the children requiring the implantation of a pacemaker. The management of fetuses diagnosed with CHB was heterogeneous across Italian Centers. The registry at present is mainly rheumatological, but involvement of pediatric cardiologists and gynecologists is planned.

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Section: Methodsmentioning

confidence: 99%

“…Several groups addressed the morbidity and mortality associated with CHB in different countries (9–13). Mortality ranges from 16 to 29%, whereas the rates of children receiving pacemaker vary from 50 to 79%, frequently within the first year of life.…”

Section: Introductionmentioning

confidence: 99%

First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry)

Fredi

Andréoli

Bacco

et al. 2019

Front. Cardiovasc. Med.

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“…10 In contrast, European groups showed that antenatal steroids did not have any significant effect on intrauterine or neonatal survival. [11][12][13] A Japanese group also showed that survival rates did not significantly differ in fetuses with or without steroid treatment. 14 Recently, Izmirly et al reported that the prompt use of fluorinated steroids did not prevent further progression and mortality in CAVB fetuses.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, their findings suggested that the prolonged use of dexamethasone may decrease the risk of additional manifestations in the fetus, such as myocarditis or cardiomyopathy, thus improving overall outcomes . In contrast, European groups showed that antenatal steroids did not have any significant effect on intrauterine or neonatal survival . A Japanese group also showed that survival rates did not significantly differ in fetuses with or without steroid treatment .…”

Section: Discussionmentioning

confidence: 99%

Predictive markers and prenatal management of isolated fetal complete atrioventricular block: A retrospective review at a single institution

Murakami

Yamamoto

Fukunaga

et al. 2017

J of Obstet and Gynaecol

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“…Importantly, second‐degree AV block is potentially reversible based on a recent meta‐analysis 80 in which overall regression to normal rhythm was reported in 24% regardless of therapy with dexamethasone 56,57,77,81,82 . Another study of 21 cases of second‐degree AV block revealed three regressing to normal rhythm with or without steroid use 83 . Clearly, this remains an unacceptably low rate, which we posit may be due to the fact that weekly fetal echo surveillance is not frequent enough to detect the <12‐hour transition period from second‐ to third‐degree AV block 84 …”

Section: Maternal Sle In the Second And Third Trimestermentioning

confidence: 99%

A review of fetal and neonatal consequences of maternal systemic lupus erythematosus

et al. 2020

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Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti‐Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.

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Fluorinated steroids do not improve outcome of isolated atrioventricular block

Cited by 36 publications

References 28 publications

First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry)

First Report of the Italian Registry on Immune-Mediated Congenital Heart Block (Lu.Ne Registry)

Predictive markers and prenatal management of isolated fetal complete atrioventricular block: A retrospective review at a single institution

A review of fetal and neonatal consequences of maternal systemic lupus erythematosus

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