{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:29:01Z","timestamp":1788305341710,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We investigated the effects of timing of detection and transplacental fluorinated steroid treatment on ventricular heart rate (HR) and age at pacemaker implantation in fetal third\u2010degree atrioventricular block (AVB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Twenty\u2010five of 31 fetuses diagnosed with Ro\/SSA autoantibody\u2010positive AVB II\u2010III at our tertiary fetal cardiology center (2000\u20132020) and AVB III as final feto\u2010neonatal outcome were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AVB was detected approximately 5\u2009weeks earlier in pregnancy if followed in a surveillance program compared to cases referred from primary care for bradycardia (20.6 [2.3] [mean (SD)] vs. 25.4 [3.2] weeks, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). AVB detected before 24\u2009weeks had higher HR than those detected later in gestation (63.3 [6.9] vs. 57.2 [6.9] bpm, <jats:italic>p<\/jats:italic>\u2009=\u20090.042), with a larger proportion having HR &gt;60\u2009bpm (80% vs. 33%, <jats:italic>p<\/jats:italic>\u2009=\u20090.041). The 17\/25 cases that received treatment with fluorinated steroid were diagnosed earlier in gestation, with higher HR at diagnosis (61.7 [7.1] vs. 54.7 [6.3] bpm, <jats:italic>p<\/jats:italic>\u2009=\u20090.026), 1\u20132\u2009weeks after diagnosis\/treatment start, and before birth (65.4 [12.4] vs. 54.9 [5.7] bpm, <jats:italic>p<\/jats:italic>\u2009=\u20090.030) than untreated cases. Overall, 11 cases were commenced on betamimetics: three at diagnosis and eight at or after the examination made 1\u20132\u2009weeks after diagnosis\/treatment start, without any HR improvement. Two of 24 surviving babies were born preterm, and 4\/24 received a neonatal pacemaker. Age at pacemaker implantation correlated significantly with HR before birth (Spearman <jats:italic>R<\/jats:italic> 0.57, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), and fetuses with HR &gt;60\u2009bpm had a higher rate of pacemaker\u2010free survival at three (90% vs. 40%, <jats:italic>p<\/jats:italic>\u2009=\u20090.018) and 12\u2009months of age (80% vs. 13%, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). The same trend was observed in pacemaker\u2010free survival at 3 months of age in fluorinated steroid\u2010treated compared to untreated cases (71% vs. 38%, ns).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data confirm that AVB III detected earlier in gestation have a higher HR, and suggest that this higher HR can be successfully maintained to the end of gestation in cases treated with fluorinated steroids. Fetuses with HR &gt;60\u2009bpm before birth had a lower rate of pacemaker implantation at 3 and 12\u2009months of age.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14988","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T12:53:45Z","timestamp":1728478425000},"page":"2433-2441","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of early detection and steroid treatment on fetal ventricular heart rate and pacemaker implantation in anti\u2010Ro\/<scp>SSA<\/scp> positive congenital heart block"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7004-504X","authenticated-orcid":false,"given":"Sven\u2010Erik","family":"Sonesson","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"},{"name":"Division of Rheumatology, Department of Medicine Karolinska Institutet  Stockholm 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