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Influence of improved antenatal detection on the outcomes of complete atrioventricular block diagnosed in fetal-neonatal life and childhood periods – a single-centre experience in South Wales for 55 years

Published online by Cambridge University Press:  27 December 2023

Derya Duman Open the ORCID record for Derya Duman [Opens in a new window] ,
Gulhan Tunca Sahin Open the ORCID record for Gulhan Tunca Sahin [Opens in a new window] ,
Graham Stuart ,
Mark Walsh ,
Massimo Caputo ,
Andrew Parry ,
Bryan Beattie ,
Christine Conner  and
Orhan Uzun Open the ORCID record for Orhan Uzun [Opens in a new window]
Derya Duman
Affiliation:
University Hospital of Wales, Cardiff, UK
Gulhan Tunca Sahin
Affiliation:
University Hospital of Wales, Cardiff, UK
Graham Stuart
Affiliation:
Bristol Royal Children’s Hospital, Bristol, UK
Mark Walsh
Affiliation:
Bristol Royal Children’s Hospital, Bristol, UK
Massimo Caputo
Affiliation:
Bristol Royal Children’s Hospital, Bristol, UK
Andrew Parry
Affiliation:
Bristol Royal Children’s Hospital, Bristol, UK
Bryan Beattie
Affiliation:
University Hospital of Wales, Cardiff, UK
Christine Conner
Affiliation:
University Hospital of Wales, Cardiff, UK
Orhan Uzun*
Affiliation:
University Hospital of Wales, Cardiff, UK Cardiff University, School of Medicine, Cardiff, UK Swansea University, School of Engineering and Sport Sciences, Swansea, UK
*
Corresponding author: O. Uzun; Email: uzun@cardiff.ac.uk
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Abstract

Objective:

This study aimed to analyse the influence of improved antenatal detection on the course, contemporary outcomes, and mortality risk factors of the complete atrioventricular block during fetal-neonatal and childhood periods in South Wales.

Methods:

The clinical characteristics and outcomes of complete atrioventricular block in patients without structural heart disease at the University Hospital of Wales from January 1966 to April 2021 were studied. Patients were divided into two groups according to their age at diagnosis: I-fetal-neonatal and II-childhood. Contemporary outcomes during the post-2001 era were compared with historical data preceding fetal service development and hence earlier detection.

Results:

There were 64 patients: 26 were identified in the fetal-neonatal period and the remaining 38 in the childhood period. Maternal antibodies/systemic lupus erythematosus disease (anti-Ro/Sjögren’s-syndrome-related Antigen A and/or anti-La/Sjögren’s-syndrome-related Antigen B) were present in 15 (57.7%) of the fetal-neonatal. Fetal/neonatal and early diagnosis increased after 2001 with an incidence of 1:25000 pregnancies. Pacemaker implantation was required in 34 patients, of whom 13 were diagnosed in the fetal-neonatal group. Survival rates in cases identified before 2001 were at 96.3% (26/27), whereas it was 83.8% (31/37) in patients diagnosed after 2001 (P > 0.05). Other mortality risk factors comprised a lower gestational week at birth, maternal antibodies, and an average ventricular heart rate of < 55 bpm.

Conclusions:

Fetal diagnosis of complete atrioventricular block is still portends high fetal and neonatal mortality and morbidity despite significantly improved antenatal detection after 2001. Pacemaker intervention is needed earlier in the fetal-neonatal group. Whether routine antenatal medical treatment might alter this outcome calls for further prospective multicentre studies.

Keywords

Atrioventricular blockfetal bradycardiapacemaker implantationelectrocardiographyechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 2 , February 2024 , pp. 412 - 420
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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