What are the current strategies for the diagnosis and management of fetal autoimmune atrioventricular block?
This review highlights that while hydroxychloroquine may prevent fetal autoimmune atrioventricular block, the use of fluorinated steroids remains controversial due to a lack of robust trial data.
Abstract: Autoimmune congenital atrioventricular block (CAVB) has been extensively studied in recent decades. The American Heart Association published guidelines for monitoring pregnant women with anti-Ro/Sjögren’s syndrome antigen A (SSA) or anti-La/Sjögren’s syndrome antigen B (SSB) autoantibodies, which are considered to increase the risk of CAVB. Information about the natural history of the disease in utero has contributed to the detection of fetuses with CAVB in the treatable stage. Hydroxychloroquine (HCQ) may be used to prevent CAVB. The lack of large randomized control trials is a major drawback to fully confirm the benefits of fluorinated steroids such as dexamethasone. Although, when combined with a β-sympathomimetic agent, the outcome of administering a fluorinated steroid in complete CAVB is still controversial. Novel treatments targeting the immunological process might prevent the recurrence of CAVB in pregnant women with previously affected children. Keywords: autoimmune congenital heart block, anti-Ro, anti-La, fetal heart block, cardiomyopathy
Wirada Hansahiranwadee (Sat,) studied this question.
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