Clinical course and outcome of antenatally detected atrioventricular block: experience of a single tertiary centre and review of the literature

Abstract Objective The objective is to study the course and outcome of fetuses with congenital atrioventricular block (AVB) in a single centre. Methods Retrospective analysis of cases diagnosed prenatally with second and third degree AVB. The clinical characteristics and outcome of fetal AVB were evaluated including in utero treatment. Results Sixty‐two cases were studied. AVB was associated with a congenital heart defect (CHD‐AVB) in 17 cases (27%), whereas it was isolated (i‐AVB) in 45 (73%), 42 of which were associated with maternal antibodies. There were nine (52.9%) live births in the CHD‐AVB group, five of which (55%) resulted in infant deaths. In the i‐AVB group, there were 40/45 (88.9%) live births and 1/40 (2.5%) infant death; 36 (90%) babies required a permanent pacemaker. The only factor predictive of postnatal death was the presence of CHD (5/9 vs 1/39 or 48.7 [3.6; 1457.7], p < 0.001). Nineteen fetuses (40.5%) with i‐AVB received steroids in utero . No difference in outcome was found between the AVB treated in utero versus the no‐treatment group in terms of permanent pacemaker placement, postnatal death or development of dilated cardiomyopathy. Conclusion The most important prognostic factor for congenital AVB is the association with CHD. In utero treatment remains questionable. © 2014 John Wiley & Sons, Ltd.