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Fetal Complete Heart Block AV block
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Fetal Complete Heart Block AV block

I am 22 weeks pregant. This week fetus heart rate was 70 bpm. Fetal echocardium revealed 2:1 AV block. I have no past history of Auto immune disease (SLE or Sjorgen), not in my family either. I have give samples to test for these antibodies. I would like to know what are the treatment options to reverse the condition. Or is it a permanent damage. If the baby survived the till the full term, after birth what are the complications?
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773637_tn?1327450515
Dear Therese,

This is a typical time for fetal atrioventricular block (AV or heart block) to show up, unfortunately.  For our other readers, the AV node is the one electrical connection between the top and the bottom of the heart.  It allows for the electrical signal to be passed from the atria, the upper chambers, to the ventricles, the bottom chambers.  There are several different circumstances that can cause fetal AV block.  One is certain kinds of congenital cardiac defects that lead to abnormal formation of the AV node.  Another can be after an infection.  However, the most common reason that we see for AV block is an autoimmune one.  This occurs when antibodies are made in the setting of systemic lupus erythematosus (SLE) or Sjögren syndrome.  These antibodies go across the placenta and literally destroy the AV node.  Often the mothers don’t even know that they have SLE or Sjögren’s, as they are frequently asymptomatic.  There is some research that has occurred in trying to stop, or even to reverse, this process by giving steroids to the mother.  However, it depends when in the process this occurs.  If it is far enough along, the AV node may be permanently damaged.

Your baby is already showing some effects of this, which the heart rate of 70.  This is quite a low rate for your baby’s heart.  It is difficult to know how your baby will do specifically without seeing what the heart anatomy and function is.  Sometimes, the baby is able to tolerate the lower heart rate and make it to term.  However, other times, the low heart rate is not enough to meet the metabolic needs of the baby.  The ability of the heart to squeeze decreases, and they can die in utero.  If they are followed closely and they look like they are getting into trouble, they can be delivered early and have a pacemaker to help with their heart function.

Overall, if everything else goes well but the AV block does not reverse, the long term prognosis for your baby is that he or she will eventually need to have a pacemaker placed.  Sometimes, babies can get to be 1 year old, or even older, before needing their pacemaker.  Your child should be followed closely by a cardiologist, looking for evidence of decreased heart function, abnormal heart rhythms, or ultra-slow heart rates that would signal the timing for pacemaker placement.  The need for a pacemaker will be a lifelong issue.  The pacemaker generators last anywhere from 5 to 10 years, depending on how much they are used, so they need to be replaced on a routine basis.  As best as we can tell, though, these children do well.  They should not do contact sports, but can certainly be athletically active.  Pacemakers even have programs in them that help the heart rate increase appropriately for exercise, then decrease when exercise is complete.  At this point, I would strongly urge you to be seen by a center with a fetal cardiology program so that you can receive specific information for your baby and you.
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773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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