Published Online
on January 14, 2008

A more recent version of this article appeared on January 29, 2008

This Article Full Text (PDF) Data Supplement All Versions of this Article: 117/4/485    most recent CIRCULATIONAHA.107.707661v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Friedman, D. M. Search for Related Content PubMed PubMed Citation Articles by Friedman, D. M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Congenital Heart Defects Prenatal Testing Hazardous Substances DB DEXAMETHASONE Related Collections Echocardiography Pediatric and congenital heart disease, including cardiovascular surgery Related Article

Submitted on April 4, 2007
Accepted on November 7, 2007

Utility of Cardiac Monitoring in Fetuses at Risk for Congenital Heart Block. The PR Interval and Dexamethasone Evaluation (PRIDE) Prospective Study

Deborah M. Friedman MD, Mimi Y. Kim ScD, Joshua A. Copel MD, Claudine Davis BS, Colin K.L. Phoon MPhil, MD, Julie S. Glickstein MD, Jill P. Buyon MD^*, for the PRIDE Investigators

From the Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ, and the Department of Pediatrics, Division of Pediatric Cardiology, New York Medical College, Valhalla, NY (D.M.F.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (M.Y.K.); Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Conn (J.A.C.); Department of Medicine, Division of Rheumatology (C.D., J.P.B.) and Department of Pediatrics, Division of Pediatric Cardiology (C.K.L.P.), New York University School of Medicine, New York; and Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, NY (J.S.G.).

^* To whom correspondence should be addressed. E-mail: Jill.Buyon{at}nyumc.org.

Background—Anti-SSA/Ro–associated third-degree congenital heart block is irreversible, prompting a search for early markers and effective therapy.

Methods and Results—One hundred twenty-seven pregnant women with anti-SSA/Ro antibodies were enrolled; 95 completed an evaluable course in 98 pregnancies. The protocol included fetal echocardiograms performed weekly from 16 to 26 weeks’ gestation and biweekly from 26 to 34 weeks. PR intervals >150 ms were considered prolonged, consistent with first-degree block. Ninety-two fetuses had normal PR intervals. Neonatal lupus developed in 10 cases; 4 were neonatal lupus rash only. Three fetuses had third-degree block; none had a preceding abnormal PR interval, although in 2 fetuses >1 week elapsed between echocardiographic evaluations. Tricuspid regurgitation preceded third-degree block in 1 fetus, and an atrial echodensity preceded block in a second. Two fetuses had PR intervals >150 ms. Both were detected at or before 22 weeks, and each reversed within 1 week with 4 mg dexamethasone. The ECG of 1 additional newborn revealed a prolonged PR interval persistent at 3 years despite normal intervals throughout gestation. No first-degree block developed after a normal ECG at birth. Heart block occurred in 3 of 16 pregnancies (19%) in mothers with a previous child with congenital heart block and in 3 of 74 pregnancies (4%) in mothers without a previous child with congenital heart block or rash (P=0.067).

Conclusions—Prolongation of the PR interval was uncommon and did not precede more advanced block. There was a trend toward more congenital heart block in fetuses of women with previously affected offspring than those without previously affected offspring. Advanced block and cardiomyopathy can occur within 1 week of a normal echocardiogram without initial first-degree block. Echodensities and moderate/severe tricuspid regurgitation merit attention as early signs of injury.

Key words: antibodies • echocardiography • heart block • immunology • pregnancy • atrioventricular node

Related Article:

Clinical Summaries
Circulation 2008 117: 453-455. [Extract] [Full Text]

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