University Hospital of Wales, Cardiff, UK.
Bristol Royal Children's Hospital, Bristol, UK.
Cardiol Young. 2024 Feb;34(2):412-420. doi: 10.1017/S1047951123003967. Epub 2023 Dec 27.
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.
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.
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.
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.
本研究旨在分析在威尔士大学医院，1966 年 1 月至 2021 年 4 月期间，改善产前检测对完全性房室传导阻滞胎儿-新生儿和儿童期病程、当代结局和死亡风险因素的影响。
研究了无结构性心脏病患者在威尔士大学医院的完全性房室传导阻滞的临床特征和结局。根据诊断时的年龄，患者分为两组：I-胎儿-新生儿期和 II-儿童期。比较 2001 年后当代的结局与胎儿服务发展前的历史数据（即更早的检测）。
共有 64 例患者：26 例在胎儿-新生儿期确诊，其余 38 例在儿童期确诊。15 例（57.7%）胎儿-新生儿期患者存在母体抗体/系统性红斑狼疮疾病（抗 Ro/Sjögren 综合征相关抗原 A 和/或抗 La/Sjögren 综合征相关抗原 B）。2001 年后，胎儿/新生儿和早期诊断的发生率增加，每 25000 例妊娠中就有 1 例。34 例患者需要植入起搏器，其中 13 例在胎儿-新生儿组中诊断。2001 年前诊断的病例存活率为 96.3%（26/27），而 2001 年后诊断的病例存活率为 83.8%（31/37）（P>0.05）。其他死亡风险因素包括出生时的胎龄较低、母体抗体和平均心室心率<55 次/分。
尽管 2001 年后产前检测明显改善，但完全性房室传导阻滞的胎儿诊断仍预示着胎儿和新生儿死亡率和发病率较高。在胎儿-新生儿组中需要更早进行起搏器干预。常规产前治疗是否会改变这一结局，需要进一步的前瞻性多中心研究。
