Maternal systemic lupus erythematosus antibodies were associated with left atrial inexcitability or conduction delay in 42% of newborns with congenital AV block requiring epicardial pacemakers.
Observational (n=31)
No
Maternal systemic lupus erythematosus can cause left atrial inexcitability and conduction delay in newborns with congenital AV block, which may complicate epicardial pacemaker implantation.
Absolute Event Rate: 42% vs 0%
BACKGROUND: Congenital atrioventricular block is a well-established immunologic complication of maternal systemic lupus erythematosus. We sought to further characterize the electrophysiological manifestations of maternal systemic lupus erythematosus on neonatal atria. METHODS AND RESULTS: Cases of isolated congenital atrioventricular block treated at our center over the past 41 years were identified. Data were extracted from clinical charts, pacemaker interrogations, ECGs, echocardiograms, and histopathological reports, when available. Of 31 patients with isolated congenital atrioventricular block, 18 were negative for maternal antibodies and had normal epicardial atrial sensing and pacing thresholds. In contrast, 12 of 13 patients with positive maternal antibodies had epicardial pacemakers, 5 (42%) of whom had left atrial (LA) inexcitability and/or atrial conduction delay. In 3 patients, the LA could not be captured despite high-output pacing. The fourth patient had acutely successful LA appendage and left ventricular lead placement. At early follow-up, an increased delay between the surface P-wave and intracardiac atrial depolarization was observed, indicative of atrial conduction delay. The fifth patient exhibited LA lead dysfunction, with atrial under-sensing and an increased capture threshold, 2 weeks after implantation. Biopsies of LA appendages performed in 2 patients showed no evidence of atrial fibrosis or loss of atrial myocytes. CONCLUSIONS: Herein, we report previously undescribed yet prevalent electrophysiological ramifications of maternal systemic lupus erythematosus, which extend beyond congenital atrioventricular block to encompass alterations in LA conduction, including LA inexcitability. These manifestations can complicate epicardial pacemaker implantation in newborns. In the absence of histological evidence of extensive atrial fibrosis, immune-mediated functional impairment of electrical activity is suspected.
Abadir et al. (Tue,) conducted a observational in Isolated congenital atrioventricular block (n=31). Maternal systemic lupus erythematosus antibodies vs. Negative for maternal antibodies was evaluated on Left atrial (LA) inexcitability and/or atrial conduction delay. Maternal systemic lupus erythematosus antibodies were associated with left atrial inexcitability or conduction delay in 42% of newborns with congenital AV block requiring epicardial pacemakers.
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