P09.01: Clinical Profiles, Outcomes of Isolated Fetal Complete Atrioventricular Block: a Retrospective Review of 14 Cases at a Single Institution

The association of anti-Ro antibodies for isolated complete atrioventricular block (CAVB) is well known. Anti-Ro antibodies are relatively common but the development of CAVB is rare. Indeed, CAVB carries significant mortality risks. The aims of this study are to seek better method identifying the high risk women for CAVB and to establish prenatal management by reviewing our experiences. The medical records of CAVB cases (n = 14, 1997–2014) and anti-Ro(+) cases without CAVB (n = 76, 2007–2014) were collected. Anti-Ro/La titers by double immunodiffusion (DID) and prevalence of anti-52kD/60kD-Ro/48kD-La by westernblot were compared between anti-Ro(+) women with (n = 10) or without CAVB (n = 76). The outcomes in CAVB cases with anti-Ro(+) were compared depending on presence (n = 5) or absence (n = 5) of active prenatal anti-inflammatory therapy (plasmapheresis or transplacental betamethasone). Regarding prophylactic plasmapheresis, the outcomes in 3 cases with previous affected child were evaluated. 10 out of 14 CAVB (71%) were developed from anti-Ro(+) women. In comparison between anti-Ro(+) cases with/without CAVB, anti-Ro titer by DID was significantly higher in CAVB groups (P < 0.01). All cases in CAVB showed high titers of anti-Ro (> × 32) and anti-52kD(+), whereas only 42% of cases without CAVB showed > ×32 titers. None of other markers showed significant differences between the groups. In CAVB, 3 cases did not survive to one year. The prognosis of 14 CAVB did not show any differences in lowest fetal heart rate or diagnosed gestational age. CAVB with prenatal anti-inflammatory therapy showed better prognosis in survival rate compared to the ones without therapy. All cases in previous affected CAVB with prophylactic plasmapheresis did not recur. More than 32 anti-Ro titer and 52kD(+) could be the threshold value determining high risk of CAVB. Prenatal anti-inflammatory therapy in CAVB and plasmapheresis in the case with previous affected child might be useful to get better prognosis.