N W E Van den Berg1, M G Slieker2, I M van Beynum3, C M Bilardo4, D de Bruijn5, S A Clur6, J M J Cornette7, I M E Frohn-Mulder3, M C Haak8, K E H van Loo-Maurus9, G T R Manten10, A B M H Rackowitz11, L A J Rammeloo12, A Reimer13, M E B Rijlaarsdam14, M W Freund15. 1. University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands. 2. University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; Radboud University Medical Center Nijmegen, Department of Pediatric Cardiology, Nijmegen, The Netherlands. 3. Erasmus University Medical Center Rotterdam, Department of Pediatric Cardiology, Rotterdam, The Netherlands. 4. University of Groningen and University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands. 5. Radboud University Medical Center Nijmegen, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands. 6. Academic Medical Center of Amsterdam, Department of Pediatric Cardiology, Amsterdam, The Netherlands. 7. Erasmus University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands. 8. Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands. 9. Maastricht University Medical Center, Department of Pediatric Cardiology, Maastricht, The Netherlands. 10. University Medical Center Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands. 11. University of Groningen and University Medical Center Groningen, Department of Pediatric Cardiology, Groningen, The Netherlands. 12. VU University Medical Center, Department of Pediatric Cardiology, Amsterdam, The Netherlands. 13. Radboud University Medical Center Nijmegen, Department of Pediatric Cardiology, Nijmegen, The Netherlands. 14. Leiden University Medical Center, Department of Pediatric Cardiology, Leiden, The Netherlands. 15. University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; University of Oldenburg, Campus Klinikum Oldenburg, Department of Pediatric Cardiology, Oldenburg, Germany. Electronic address: freund.matthias@klinikum-oldenburg.de.
Abstract
INTRODUCTION: Congenital atrioventricular block (CAVB) is a rare disorder with a significant morbidity and mortality. Consensus regarding the prescription and efficacy of prenatal corticosteroids is lacking. This nationwide study was initiated to evaluate the effects of prenatal treatment with corticosteroids on the outcome of CAVB in The Netherlands. METHODS: All fetuses identified with isolated congenital AVB-II° or AVB-III° in any of the eight academic fetal heart centers of The Netherlands between 2003 and 2013 were included and reviewed. RESULTS: Fifty-six fetuses were included. Fourteen (25%) fetuses were treated with dexamethasone. We found no differences between the steroid-treated and untreated cases regarding in utero progression of the AVB (63% vs 67% respectively), survival to birth (86% vs 84%), pacemaker implantations (74% vs 58%) or long-term dilated cardiomyopathy (13% vs 17%). Steroid treated fetuses demonstrated more in utero growth restriction (38% vs 11%). CONCLUSION: No benefit from prenatal corticosteroid treatment was demonstrated for fetuses with isolated CAVB in this study. However, we found negative side effects. Our data provide no evidence to support the routine administration of corticosteroids for the treatment of fetal CAVB.
INTRODUCTION:Congenital atrioventricular block (CAVB) is a rare disorder with a significant morbidity and mortality. Consensus regarding the prescription and efficacy of prenatal corticosteroids is lacking. This nationwide study was initiated to evaluate the effects of prenatal treatment with corticosteroids on the outcome of CAVB in The Netherlands. METHODS: All fetuses identified with isolated congenital AVB-II° or AVB-III° in any of the eight academic fetal heart centers of The Netherlands between 2003 and 2013 were included and reviewed. RESULTS: Fifty-six fetuses were included. Fourteen (25%) fetuses were treated with dexamethasone. We found no differences between the steroid-treated and untreated cases regarding in utero progression of the AVB (63% vs 67% respectively), survival to birth (86% vs 84%), pacemaker implantations (74% vs 58%) or long-term dilated cardiomyopathy (13% vs 17%). Steroid treated fetuses demonstrated more in utero growth restriction (38% vs 11%). CONCLUSION: No benefit from prenatal corticosteroid treatment was demonstrated for fetuses with isolated CAVB in this study. However, we found negative side effects. Our data provide no evidence to support the routine administration of corticosteroids for the treatment of fetal CAVB.
Authors: Armia Michael; Ahmad A Radwan; Ahmed Kamel Ali; Ahmed Yassien Abd-Elkariem; Sherif A Shazly Journal: Eur J Obstet Gynecol Reprod Biol X Date: 2019-06-16