Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti–SSA/Ro 52-kd antibodies
Article first published online: 5 APR 2004
Copyright © 2004 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 50, Issue 4, pages 1253–1261, April 2004
How to Cite
Sonesson, S.-E., Salomonsson, S., Jacobsson, L.-A., Bremme, K. and Wahren-Herlenius, M. (2004), Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti–SSA/Ro 52-kd antibodies. Arthritis & Rheumatism, 50: 1253–1261. doi: 10.1002/art.20126
- Issue published online: 5 APR 2004
- Article first published online: 5 APR 2004
- Manuscript Accepted: 17 DEC 2003
- Manuscript Received: 11 SEP 2003
- Swedish Research Council
- Karolinska Institutet
- Sigurd and Elsa Golje's Foundation
- Swedish Society for Medical Research
- Freemason's Foundation
- Signe and Reinhold Sund's Foundation
- Samariten Foundation
- General Maternity Hospital Foundation
- Queen Silvia's Jubilee Foundation
- Prof. Nanna Svartz' Foundation
- King Gustaf V's 80-Year Foundation
- Börje Dahlin Foundation
- Clas Groschinsky Foundation
- Emil and Wera Cornell Foundation
- Heart-Lung Foundation
- Swedish Rheumatism Association
To prospectively investigate the development of fetal heart block in anti–SSA/Ro 52-kd–positive women, and to evaluate the usefulness of serial Doppler echocardiography in detecting early signs of congenital heart block.
Twenty-four women with anti–SSA/Ro 52-kd antibodies and consequently increased risk for fetal heart block were followed up weekly, between 18 and 24 weeks of gestation, with two Doppler echocardiographic methods designed to estimate the time delay between hemodynamic events caused by atrial and ventricular depolarizations. Two hundred eighty-four women with normal pregnancies served as controls. Anti–Ro 52-kd, anti–Ro 60-kd, and anti-La antibodies were investigated by immunoblotting and enzyme-linked immunosorbent assay using recombinant proteins.
In anti–Ro 52-kd–positive women, fetal atrioventricular (AV) time intervals were longer and heart rates were slightly lower compared with those in controls. Eight of 24 fetuses had signs of first-degree block. One of these fetuses had progression to complete block, and another showed recovery from second-degree block to first-degree block with betamethasone treatment. In the remaining 6 fetuses, spontaneous normalization occurred before or shortly after birth. Fetuses with normal AV time intervals at 18–24 weeks had normal electrocardiographic results at birth.
Anti–Ro 52-kd–positive pregnant women frequently carry fetuses with Doppler echocardiographic signs of first-degree AV block. These blocks revert spontaneously in the majority of fetuses, but progression to a more severe degree of block may occur in some. Serial Doppler echocardiographic measurement of AV time intervals is suggested as a useful method for surveillance of these high-risk pregnancies.