Key result
Transplacental administration of dexamethasone, intravenous immunoglobulin, and hydroxychloroquine cannot reverse third-degree atrioventricular blocks but may prevent progression of first- and second-degree blocks.
Why the study?
Approaches for managing autoimmune-mediated congenital heart block remain controversial, and there is still no accessible clinical strategy for this potentially life-threatening condition.
This review provides an integrated prenatal management strategy and clinical advice for fetal immune-associated congenital heart block, an area where clinical strategies remain controversial.
Emerging clues on fetal immune CHB may refine prenatal monitoring; leaves open optimal interventions pending prospective trials.
Fetal congenital heart block (CHB) is the most commonly observed type of fetal bradycardia, and is potentially life-threatening. More than 50% of cases of bradycardia are associated with maternal autoimmunity, and these are collectively termed immune-associated bradycardia. Several methods have been used to achieve reliable prenatal diagnoses of CHB. Emerging data and opinions on pathogenesis, prenatal diagnosis, fetal intervention, and the prognosis of fetal immune-associated CHB provide clues for generating a practical protocol for clinical management. The prognosis of fetal immune-associated bradycardia is based on the severity of heart blocks. Morbidity and mortality can occur in severe cases, thus hieratical management is essential in such cases. In this review, we mainly focus on optimal strategies pertaining to autoimmune antibodies related to CHB, although the approaches for managing autoimmune-mediated CHB are still controversial, particularly with regard to whether fetuses benefit from transplacental medication administration. To date there is still no accessible clinical strategy for autoimmune-mediated CHB. This review first discusses integrated prenatal management strategies for the condition. It then provides some advice for clinicians involved in management of fetal cardiovascular disorder.
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Liao et al. (2021) conducted a review in Immune-Associated Congenital Heart Block. Transplacental medication (dexamethasone, hydroxychloroquine, IVIG) was evaluated. Transplacental administration of dexamethasone, intravenous immunoglobulin, and hydroxychloroquine cannot reverse third-degree atrioventricular blocks but may prevent progression of first- and second-degree blocks.
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