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Fluorinated Steroids do not improve Outcome of Isolated Atrioventricular
Block
N.W.E. Van den Berg, M.G. Slieker, I.M. van Beynum, C.M. Bilardo,
D. de Bruijn, S.A. Clur, J.M.W. Cornette, I.M.E. Frohn-Mulder, M.C. Haak,
K.E. van Loo-Maurus, G.T.R. Manten, A.B.M.H. Rackowitz, L.A.J. Ram-
meloo, A. Reimer, M.E.B. Rijlaarsdam, M.W. Freund
PII: S0167-5273(16)32639-0
DOI: doi:10.1016/j.ijcard.2016.09.119
Reference: IJCA 23726
To appear in: International Journal of Cardiology
Received date: 23 May 2016
Revised date: 25 September 2016
Accepted date: 29 September 2016
Please cite this article as: Van den Berg NWE, Slieker MG, van Beynum IM, Bilardo CM,
de Bruijn D, Clur SA, Cornette JMW, Frohn-Mulder IME, Haak MC, van Loo-Maurus
KE, Manten GTR, Rackowitz ABMH, Rammeloo LAJ, Reimer A, Rijlaarsdam MEB,
Freund MW, Fluorinated Steroids do not improve Outcome of Isolated Atrioventricular
Block, International Journal of Cardiology (2016), doi:10.1016/j.ijcard.2016.09.119
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Fluorinated Steroids do not improve Outcome of Isolated
Atrioventricular Block.
Authors: Van den Berg N.W.E.[1,2], Slieker M.G.[1,3], van Beynum I.M.[4], Bilardo C.M.[5], de
Bruijn D.[3], Clur S.A.[6], Cornette J.M.W.[4], Frohn-Mulder I.M.E.[4], Haak M.C.[6,7], van Loo-
Maurus K.E.[8], Manten G.T.R.[1], Rackowitz A.B.M.H.[5], Rammeloo L.A.J.[9], Reimer A.[3],
Rijlaarsdam M.E.B.[10], Freund M.W.[1,11].
Statement of Authorship: All authors take full responsibility for all aspects of the reliability
and freedom from bias of the data presented and their discussed interpretation.
Corresponding author: M.W.Freund. freund.matthias@klinikum-oldenburg.de
Conflicts of interest: None
Grant Support: None
Key words: Heart block, Antibodies, Cardiomyopathy, Congenital Atrioventricular Block.
Word count: abstract: 182 article: 2649
[1] University Medical Center Utrecht, Department of Pediatric Cardiology, Obstetrics and Gynecology,
Utrecht, The Netherlands.
[2] Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental
Cardiology and Cardiothoracic Surgery, Amsterdam, The Netherlands.
[3] Radboud University Medical Center Nijmegen, Departments of Pediatric Cardiology, Obstetrics and
Gynecology , Nijmegen, The Netherlands.
[4] Erasmus University Medical Center Rotterdam, Departments of Pediatric Cardiology, Obstetrics and
Gynecology, Rotterdam, The Netherlands.
[5] University of Groningen and University Medical Center Groningen, Departments of Pediatric Cardiology,
Obstetrics and Gynecology, Groningen, The Netherlands.
[6] Academic Medical Center of Amsterdam, Departments of Pediatric Cardiology, Amsterdam, The
Netherlands.
[7] Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands.
[8] Maastricht University Medical Center, Department of Pediatric Cardiology, Maastricht, The
Netherlands.
[9] VU University Medical Center, Department of Pediatric Cardiology, Amsterdam, The Netherlands.
[10] Leiden University Medical Center, Department of Pediatric Cardiology, Leiden, The Netherlands.
[11] University of Oldenburg, Campus Klinikum Oldenburg, Department of Pediatric Cardiology,
Oldenburg, Germany.

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Abstract
Introduction. Congenital atrioventricular block (CAVB) is a rare disorder with a
significant morbidity and mortality. Consensus regarding the prescription and efficacy
of prenatal corticosteroids is lacking. This nationwide study was initiated to evaluate
the effects of prenatal treatment with corticosteroids on the outcome of CAVB in the
Netherlands.
Methods. All fetuses identified with isolated congenital AVB-II˚ or AVB-III˚ in any of
the eight academic fetal heart centers of The Netherlands between 2003-2013 were
included and reviewed.
Results. Fifty-six fetuses were included. Fourteen (25%) fetuses were treated with
dexamethasone. We found no differences between the steroid-treated and untreated
cases regarding in utero progression of the AVB (63% vs 67% respectively), survival to
birth (86% vs 84%), pacemaker implantations (74% vs 58%) or long-term dilated
cardiomyopathy (13% vs 17%). Steroid treated fetuses demonstrated more in utero
growth restriction (38% vs 11%).
Conclusion. No benefit from prenatal corticosteroid treatment was demonstrated for
fetuses with isolated CAVB in this study. However, we found negative side effects.
Our data provide no evidence to support the routine administration of corticosteroids
for the treatment of fetal CAVB.

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1. Introduction
Isolated congenital atrioventricular block (CAVB) is a rare disorder affecting
approximately one in every 15.000-23.000 live births.[1,2] CAVB is typically associated
with an anti-Ro/SSA immune mediated inflammatory process in the AV-node. Likewise,
antibodies may affect the myocardium and trigger endocardial fibroelastosis (EFE) or
dilated cardiomyopathy (DCM).[3–6] CAVB is the most common presentation of this
cardiac neonatal lupus syndrome and is associated with a significant morbidity and
mortality. Approximately 70% of deaths occur in utero.[1,7,8]
Fluorinated steroids have an important role in contemporary treatment regimens and
aim to suppress the inflammatory processes in the myocardium and the AV-node.[9]
Available evidence is limited and contradictory, where a few studies suggest a positive
effect of steroids on AVB progression, fetal survival or cardiac function [10,11], but
more recently published large fetal registrations describe no significant effect of
treatment.[7,8,12–14]
Debate concerning the therapeutic effect of corticosteroids remains and steroids are
still being prescribed. Imprudent administration may however result in harmful side-
effects to the mother and fetus. Fetal growth and brain-development may be affected
in particular.[15–19] It is thus of critical importance to continue to appraise
contemporary treatment regimens and to consider the risk-benefit ratio of prenatal

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treatment strategies. This study aims to describe the current practice in The
Netherlands and to assess the positive and negative effects of corticosteroid
treatment regimens on fetal and postnatal cardiac outcome.

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2. Methods
2.1 Study Population
We included all consecutive cases that were referred to a department of fetal
medicine in any of the eight university hospitals of the Netherlands between 2003
and 2013 and were diagnosed with isolated AVB-II˚ or AVB-III˚. We identified cases
from the prenatal ultrasound databases (MOSOS or ASTRAIA) in all tertiary centers.
Fetal cases were prospectively entered in these databases. We cross-checked the case
lists with cases from the pediatric cardiology departments. There is a close
collaboration between gynecologists and pediatric cardiologists in each center.
2.2 In- and Exclusion Criteria
We included fetuses with a diagnosis of isolated AVB-II° or AVB-III°. All
echocardiograms made at first diagnosis of AVB were reassessed by a specialist from
the participating center and a member of the steering sub-committee. After
discussion, previously made diagnoses were revised if necessary.
We excluded cases with complex congenital heart disease, long QT syndrome or
chromosomal abnormalities as these were not considered to have “isolated” CAVB.
Cases with isolated secundum atrial septal defects (ASD) and/or patent ductus
arteriosus were considered to have minor cardiac anomalies and were not

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excluded.[21] The presence of anti-Ro-SSA (SSA) antibodies was not an inclusion
criterion in this study, but a subgroup analysis excluding all SSA negative cases was
performed.
2.3 Data Collection and Outcome Measures
We collected serial follow-up data of the fetus regarding atrial and ventricular heart
rate (HR), ventricular function, hydrops and in utero growth, from prospectively
entered fetal echo databases. Data obtained from medical files included: maternal
age, autoimmune disease, trans placental treatment type, dose and duration,
pacemaker implantation, survival and neurodevelopmental status. Prospectively entered
echocardiographic databases (ECHOPAC) were consulted for data on long-term cardiac
function and DCM.
AVB-II˚ was defined as the intermittent mechanical dissociation of atrial and
ventricular activation and AVB-III˚ as the complete mechanical dissociation of atrial
and ventricular activation diagnosed by M-mode echocardiography.[20] We defined
fetal hydrops as the presence of effusion in two or more compartments of the fetal
body. In utero growth restriction was defined as an abdominal circumference below
the 10th
percentile. We defined neonatal respiratory insufficiency as a duration of the
mechanical ventilation exceeding ≥12 hours. Dilated cardiomyopathy was diagnosed in

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case of a shortening fraction <25% with a left ventricular end diastolic diameter z-
score >2 that was adjusted to the body-surface area.[22,23]
We evaluated fetal outcome by the rate of in utero fetal demise, hydrops,
progression of AVB and birth weight. We evaluated postnatal outcome by the rate of
pacemaker implantations, the development of DCM and reported neurodevelopmental
impairment at last follow-up. The study was approved by the institutional ethics
board of the University Medical Center Utrecht and complies with the declaration of
Helsinki.
2.4 Statistical analysis
We determined and compared two groups based on the assignment of fetal fluorinated
steroids. These groups were used to analyze fetal and postnatal outcome. Comparisons
between groups were performed with Fisher’s exact test for categorical variables and the
Student’s t test for continuous variables. We performed a subgroup analysis excluding all anti-
Ro-SSA negative cases.
Data are presented as frequencies, mean and SD or median with range. Gestational age (GA)
is presented as weeks with days (wks.days). All performed tests were 2 sided and values of
P<0.05 were considered statistically significant (IBM SPSS software version 22; SPSS Inc.,
Chicago, IL, USA).

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3. Results
3.1 Patient Characteristics
We identified 65 fetuses with a diagnosis of CAVB in the databases of the eight
participating centers. Four fetuses provided insufficient data for analysis because they
were predominantly monitored in a collaborating non-academic center. Five fetuses
were excluded because of concomitant congenital heart disease or chromosomal
abnormalities.(figure 1)
Eighty-seven percent of women were anti-Ro/SSA positive. None of the women with
negative antibody titers was retested later in any of the participating centers, making
it unlikely that they developed manifest auto-immune disease during the course of
follow-up.
Twenty-one fetuses were diagnosed with AVB-II˚ (38%) and 35 with AVB-III˚ (62%). A
diagnosis of AVB-II˚ had been revised in 10 cases after reassessment of the
echocardiogram by the researchers. Table 1 describes the clinical characteristics of 56
included fetuses.
Five pregnancies (9%) were terminated for various reasons: two were twin
pregnancies affecting only one fetus; in one pregnancy, the fetus had brain
malformation; one pregnancy was terminated because of a poor fetal prognosis and
in the last case, the parents opted for termination because their previous child

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required a heart transplantation for CAVB. Eight of the 51 remaining fetuses died in
utero (16%). Forty-three fetuses were live born: seven with AVB-II˚ and 36 with AVB-
III˚. A large proportion of fetuses was delivered vaginally (84%) in accordance with
Dutch standards. Monitoring during delivery was achieved by cardiotocography or with
regular fetal scalp pH testing.
3.2 Fluorinated Steroids and other treatment regimens
None of the participating centers systematically administered trans placental treatment
for CAVB. Table 1 shows the characteristics of the fetuses treated with steroids
compared to those with expectant management. Both groups were similar except for
a higher prevalence of maternal manifest auto-immune disease and a higher
prescription rate of betamimetics in the steroid treated group. Both were not related
to fetal outcome in this study.
Fluorinated steroids were administered in 14 (27%) pregnancies, which was started
directly upon, or one visit following the first diagnosis of AVB-I° or AVB-II° in 12
cases. The median GA at treatment was 23.6 wks (range 20.1-30.1 wks). All steroid
treatment regimens consisted of dexamethasone given at a median initial dose of 8
mg/d (range 2mg-16mg/d). Administration dosage was reduced in four (29%) and

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raised in one case. A psychosis as a reported side effect occurred in one pregnant
woman.
Ten steroid-treated fetuses (71%) received betamimetics as well. Fetuses that received
betamimetics had lower HRs at diagnosis compared to fetuses that were not treated
with betamimetics (58bpm vs 69bpm; p=0.02). In total, betamimetics were prescribed
in 17 (32%) pregnancies: salbutamol in 14 (82%) and terbutaline in 3 (18%), but were
unrelated to fetal or postnatal outcome. In none of the pregnancies, plasmapheresis
or intravenous immunoglobulins (IVIG) were administered, but in one case
hydrochloroquine had been prescribed.
3.3 Corticosteroids and fetal outcome
We found no difference between the fetuses treated with or without steroids
regarding in utero fetal demise (14% vs 16% respectively, p=1.00) or fetal progression
from AVB-II° to AVB-III° (63% vs 66%, respectively; p=1.00). (Table 2, figure 2) One
fetus identified with AVB-I˚ at 24.5 wks GA received steroids, yet progressed
thereafter to AVB-II˚ and AVB-III˚ subsequently. In utero growth restriction was
reported more often in steroid treated fetuses (38% vs 11%; p=0.04) with a
corresponding birth weight that was one kilogram lower(p<0.001).

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3.4 Fetal regressive AVB
In utero regression of AVB was observed in three fetuses. Two fetuses with AVB-II˚
regressed to sinus rhythm (SR) in utero and one fetus to AVB-I˚. The first fetus, from
an SSA seronegative mother, did not receive steroids. The second fetus had been
treated with steroids since diagnosis of AVB-II˚ and converted to SR. The third fetus
regressed to AVB-I° spontaneously, whereupon steroids were initiated for the first
time. The child progressed to AVB-II° two weeks after birth.
3.5 Corticosteroids and postnatal outcome
There was no difference between the steroid and non-steroid treated group in the
proportion of pacemaker implants at last follow-up (58% vs 74%; p=0.46) or the
prevalence of DCM (17% vs 13%; p=1.00). In this study, one death occurred that was
caused by a mechanical pacemaker complication.
In total, six children developed DCM at a median age of 1.8 years (IQR 1.5-3.3). All
children who developed DCM had previously received a pacemaker, four in the
neonatal period. Two DCM children were transplanted who had not received steroids;
one was from an SSA seronegative mother.
At last follow-up, parents reported four children to have delayed neuro-motor
development (this does not include one case with hemiplegia that suffered a

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cerebrovascular event); three had been treated with steroids. However, impaired
neuro-motor development could not be objectified in any of these cases. One child
attended special education because of language impairment and another child tested
for language impairment scored below average, but within normal range.
A subgroup analysis excluding all cases without positive maternal antibodies had no
relevant effect on any of the described prenatal or postnatal outcome parameters.

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4. Discussion
This study demonstrates the absence of an effect of prenatal corticosteroids in a non-
randomized cohort of fetuses with CAVB. There was no consensus on management
strategies between the different centers in The Netherlands, which should be
improved. We have not performed a randomized controlled trial and allocation bias is
therefore not unlikely, but the non-systematic treatment allocation of corticosteroids
resulted in comparable subgroups of steroid and non-steroid treated fetuses. This
enabled us to compare the fetal and long-term outcome of these two groups. We
could not find a benefit from steroid treatment on survival or progression of the
disease, but did find distinct adverse effects.
The rationale behind the prescription of fluorinated steroids, from a pathophysiological
perspective, is to target the inflammatory process that causes calcium load
dysregulation and apoptosis followed by permanent fibrosis and calcification.[24,25]
Clinical data to support the administration of steroids is mainly based on one of the
first publications about the issue by Jaeggi et al.[10], who found an improved
cumulative fetal and one year survival following in utero steroid treatment. He
compared 37 fetuses from two different eras: the historical controls from 1990-1996
did not receive steroids, whereas all fetuses between 1996-2003 were systematically
treated. However, the difference in mortality in this study, cannot simply be ascribed

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to the administration of steroids. First, Jaeggi et al. reported a neonatal mortality of
47% in the untreated population, which is significantly higher than reported in other
studies. Secondly, patients included in the first era had more risk factors for a poor
prognosis. Their results should therefore be interpreted with caution.
We found a similar proportion of in utero fetal demise compared to Jaeggi et al,
which is higher compared to other reports. An explanation can be found in our
population based design and comprehensive search of fetal databases, identifying
more fetuses with in utero fetal demise. Moreover, early referrals in the Netherlands
may explain the lower gestational ages at diagnosis of CAVB in this study, which is
associated with a poor prognosis.
Our data on neonatal and long-term mortality are rather in line with more recently
published large retrospective studies. One study from a European/Brazilian
collaboration included 175 fetal cases and found 4% mortality in the untreated group
and 5% mortality in the steroid treated group at 1 month.[7] Another large study
from the Research Registry for Neonatal Lupus (RRNL) including 325 fetuses, found a
higher in utero fetal demise rate in steroid treated fetuses and attributed this to the
severity of the disease.[8]
Apart from the supposed benefit of steroids on mortality, steroids have been
suggested for the primary or secondary prevention of AVB or to induce regression.

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[26] Reports on the regression of AVB are usually limited to case reports or series
[11,27–29], but a pooled analysis of the European/Brazilian and RRNL cases, does
suggest a potential for steroid induced conversion of AVB (p=0.053).[30] However, a
more recent large French registry in 214 cases found no effects of steroid treatment
on AVB progression or regression.[13] This is corresponding to our study, as we found
no difference in the proportion of AVB-II˚ progression between steroid-treated and
untreated fetuses and observed only an incidental case of AVB regression.
While the generalized benefit from fluorinated steroids to treat fetal isolated CAVB
should be reassessed, certain risk groups have been identified that may benefit from
treatment. For instance, case series have reported positive effects in fetuses with
hydrops.[28,31] Also, the long-term cardiac effects should be taken into
account.[4,5,28] A study by the group of Jaeggi, including 20 fetuses with
cardiomyopathy or EFE, suggests a potential benefit from steroids in combination with
IVIG on long-term cardiac function.[32] However, a recent publication from the
Research Registry for Neonatal Lupus addressed the long-term effects of steroids on
DCM and PM implantations in a cohort of 156 fetal cases and, like our study, could
not demonstrate an effect from steroid treatment.[14]
The supporting evidence for the administration of fluorinated steroids remains
controversial and too little attention is being paid to their potential adverse

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effects.[15,17,18] In this study, we describe a serious case of maternal psychosis.
Moreover, maternal side effects are likely underreported. We found steroid treated
fetuses to be more likely to have IUGR, to be born earlier and to have significantly
lower birth weights. Besides, fetal steroid treatment has been associated with long-
term impaired neurodevelopmental outcome. In this study, there were more
subjectively reported cases of neuro-motor impairment in the steroid treated group.
One prospective study evaluating the long-term neurodevelopmental outcome of CAVB
in fetal steroid on non-steroid treated children, found no neurodevelopmental effect
of treatment [19], but this potential consequence still needs further study.
5. Limitations
There are several limitations to this study. Firstly, the classification of AVB with M-
mode or Doppler echocardiography remains debatable. However, we reassessed the
echocardiograms and revised diagnosis if necessary.
Furthermore, some fetuses eligible for inclusion may have been missed or were
excluded from the analysis due to monitoring in any other than one of the
participating tertiary referral centers, thereby introducing possible selection bias. Non
the less, we believe that we were able to include most of the fetuses with isolated
CAVB in the Netherlands.

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The disease is rare and absolute numbers are inherently small with varying follow-up
durations, thereby compromising the analysis of subgroups that have been proposed
to benefit from steroid treatment. The lack of standardized follow-up strategies, with
various treatment regimens and frequently missing data regarding treatment
indication, maternal antibody titers and antibody subtypes or data on the presence
EFE, greatly complicated the evaluation of treatment effects in subgroups and
emphasizes the importance of standardized treatment regimens. Nevertheless, this
study was able to provide new data from a not previously described cohort of CAVB,
which supports existing evidence for a lack of general benefit from steroid treatment
and clearly demonstrated adverse effects.

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6. Conclusions
Our study does not support the general administration of steroids in fetuses
diagnosed with AVB-II˚ or AVB-III˚. Fetal CAVB is a rare disease and international fetal
and pediatric cardiac centers should collaborate to enable a sufficiently powered
randomized controlled trial, stratified by the presence of risk factors, to study the
short and long-term effects of corticosteroids and settle the debate. Until then,
corticosteroids should not be administered indiscriminately for the treatment of fetal
CAVB.

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Figure Captions
Figure 1. Identified fetuses with AVB-II˚ or AVB-III˚. CHD, congenital heart disease; VSD,
ventricular septal defect.
Figure 2. Outcome of all fetuses with AVB-II˚ or AVB-III˚ according to steroid treatment.
Termination of pregnancy is excluded. IUFD, in utero fetal demise.

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Figure 1

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Figure 2

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Table 1. Clinical Characteristics of 56 Fetuses diagnosed with isolated AVB-II˚ or
AVB-III˚.
*Termination of pregnancy excluded;
In case of incomplete data, frequencies are presented as the proportion of available cases.
CAVB, congenital atrioventricular block; SLE, Systemic Lupus Erythematosus; GA, gestational age; wks.days, weeks
and additional days; HR, heart rate; bpm, beats per minute;
n (%) All Cases
(n=56)
Steroid treatment
(n=14)
No Steroid treatment
(n=42) P-Value
Males 21/52 (40) 4 (29) 17/38 (45) 0.4
Maternal age (years)(mean ± SD) 31 ±5 30 ±3 31 ±6 0.6
History of CAVB pregnancy 4/55 (7) 1 (7) 3/41 (7) 1.0
Positive maternal antibodies
Anti-Ro/SSA
Anti-La/SSB
Lupus anticoagulant
Known before CAVB diagnosis
49/55 (89)
48
35
1
19/47 (40)
13 (93)
13
10
0
7/12 (58)
36/41 (88)
35
25
1
12/35 (34)
1.0
NA
NA
NA
0.2
Maternal auto-immune disease
SLE
Sjögren’s
other
24/55 (44)
8
11
5
10/13 (77)
4
3
3
14 (33)
4
8
2
0.01
NA
NA
NA
Diagnosis AVB-II˚, III˚ 21, 35 (38, 62) 8, 6 (57, 43) 13, 29 (31, 69) 0.1
GA diagnosis (wks.days)(mean ± SD)
AVB-II˚
AVB-III˚
23.4 ±5
24.4 ±5
22.4 ±4
22.6 ±3
21.6 ±2
24.2 ±4
23.6 ±5
27.1 ±7
22.3 ±3
0.8
0.06
0.3
HR at diagnosis (bpm)(mean ± SD)
AVB-II˚
AVB-III˚
65 ±16
71 ±13
60 ±16
65 ±13
71 ±14
59 ±10
66 ±16
76 ±14
62 ±15
0.9
0.5
0.6
Minimal in utero HR (bpm)(mean ± SD) 56 ±14 55 ±15 56 ±13 1.0
Hydrops at diagnosis CAVB 5/50 (10) 1/12 (8) 4/38 (11) 1.0
Twin pregnancy 5 (9) 2 (14) 3 (7) NA
Termination of pregnancy 5 (9) 0 5 NA
Betamimetic treatment 17 (30) 10 (71) 7 (17) <0.01
Non-fluorinated steroid treatment 2 (4) 0 2 (5) 1.0
In utero fetal demise* 8/51 (16) 2 (14) 6/37 (16) 1.0

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Table 2. Outcome of 51 fetuses with and without steroid treatment.
Termination of pregnancy is excluded from all analyses.
*This includes two cases transplanted for severe dilated cardiomyopathy.
In cases with incomplete data, frequencies are presented as the proportion of available cases. Postnatal outcome
parameters are limited to the analysis of live births. IQR, interquartile range
n (%) All Cases
(n=51)
Steroid treatment
(n=14)
No Steroid treatment
(n=37) P-Value
Follow-up duration (years)(IQR) 4 (2-7) 2 (1-6) 5 (2.5-7.5) 0.2
In utero fetal demise 8 (14) 2 (14) 6 (16) 1.00
In utero acquired hydrops 7/45 (16) 2/11 (18) 5/34 (15) 1.00
Progression to AVB-III˚ 13/20 (65) 5/8 (63) 8/12 (67) 1.00
Abdominal circumference p<10 9/49 (18) 5/13 (38) 4/36 (11) 0.04
Caesarean section
AVB-II˚
AVB-III˚
18/42 (43)
3/6 (50)
15/36 (42)
8/12 (67)
1/3 (33)
7/9 (78)
10/30 (33)
2/3 (66)
8/27 (30)
0.08
1.00
0.02
GA at birth (wks.days)(mean ± SD) 38 ±2 36 ±3 39 ±2 <0.01
Birth weight, (kg)(mean ± SD) 2.884 ±0.71 2.165 ±0.53 3.193 ±0.54 <0.01
AVB-III˚ at birth 36/43 (84) 9/12 (75) 27/31 (87) 0.4
HR at birth (bpm)(mean ± SD)
AVB-II˚
AVB-III˚
78 ±24
60 ±15
80 ±39
52 ±6
62 ±16
63 ±16
0.3
0.2
Neonatal Respiratory Distress 12/41 (29) 3/11 (27) 9/30 (30) 1.0
Neonatal Lupus Erythematosus 3/42 (7) 1/12 (8) 2/30 (7) 1.0
Neonatal Pacemaker Implantation 18/43 (42) 4/12 (33) 14/31 (45) 0.7
Pacemaker Implantations 30/43 (70) 7/12 (58) 23/31 (74) 0.5
Dilated Cardiomyopathy at last follow-up 6/42 (14) 2/12 (17) 4*/30 (13) 1.0
Language Impairment 1/43 (2) 0/12 (0) 1/32 (3) NA
Neuro-motor Impairment 4/43 (9) 3/12 (25) 1/32 (3) <0.05