Van den Berg N W E, Slieker M G, van Beynum I M, Bilardo C M, de Bruijn D, Clur S A, Cornette J M J, Frohn-Mulder I M E, Haak M C, van Loo-Maurus K E H, Manten G T R, Rackowitz A B M H, Rammeloo L A J, Reimer A, Rijlaarsdam M E B, Freund M W
University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands.
University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; Radboud University Medical Center Nijmegen, Department of Pediatric Cardiology, Nijmegen, The Netherlands.
Int J Cardiol. 2016 Dec 15;225:167-171. doi: 10.1016/j.ijcard.2016.09.119. Epub 2016 Sep 30.
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.
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.
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%).
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.
先天性房室传导阻滞（CAVB）是一种罕见疾病，具有较高的发病率和死亡率。目前对于产前使用皮质类固醇的处方和疗效缺乏共识。开展这项全国性研究以评估在荷兰产前使用皮质类固醇治疗对CAVB结局的影响。
纳入并回顾了2003年至2013年期间在荷兰八个学术性胎儿心脏中心中任何一个被诊断为孤立性先天性二度或三度房室传导阻滞的所有胎儿。
共纳入56例胎儿。14例（25%）胎儿接受了地塞米松治疗。我们发现，在房室传导阻滞的宫内进展（分别为63%和67%）、出生存活率（86%和84%）、起搏器植入率（74%和58%）或长期扩张型心肌病发生率（13%和17%）方面，接受类固醇治疗和未接受治疗的病例之间没有差异。接受类固醇治疗的胎儿表现出更多的宫内生长受限（38%和11%）。
本研究未证明产前皮质类固醇治疗对孤立性CAVB胎儿有益。然而，我们发现了负面副作用。我们的数据没有提供证据支持常规使用皮质类固醇治疗胎儿CAVB。
