SYMPTOMATIC CONGENITAL COMPLETE ATRIOVENT RICULAR-BLOCK - A MEDICAL CHALLENGE

Congenital complete atrioventricular block is a rare entity. The assoc iation between this disease, maternal connective tissue disease and ma ternal antibodies [anti-Ro (SS-A) resp. anti-La (SS B)] is well known. Diagnosis can be made by means of fetal Doppler-echocardiography by t he 16th week of gestation. In our case diagnosis was established in th e 21st week of gestation. Ventricular rate was 55/min, atrial rate 70/ min. There were no signs of fetal hydrops. There were no signs of mate rnal connective tissue disease, but anti-Ro and anti-La antibodies cou ld be detected. The mother was treated with steroids from the time of diagnosis until the end of pregnacy. Altogether 9 Doppler-echocardiogr aphic studies were performed. A recurrance of normal rhythm did not oc cur. A slow but continuous decrease of atrial and ventricular rate was observed. Interestingly, there was no development of fetal hydrops un til the very end of pregnancy when the fetal heart rate reached a low of 28 beats per minute. We speculate, that the therapy with steroids m ight have played an important role in the prevention of early hydrops. At the onset of fetal hydrops delivery should be considered. In sympt omatic complete atrioventricular block we prefer the implantation of a permanent pacemaker system immediately after birth. Efficient care fo r the fetus resp. the newborn can only be achieved through well planne d cooperation.