{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:21:08Z","timestamp":1784744468773,"version":"3.55.0"},"reference-count":24,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,2]]},"abstract":"<jats:p>OBJECTIVE: To establish identifiable prenatal factors in fetal heart block which might predict death in utero, the need for intervention, or the probability of pacemaker requirement. SETTING: Tertiary referral unit for fetal echocardiography. SUBJECTS: 36 fetuses with congenital complete heart block and structurally normal hearts identified between 1980 and 1993. METHODS: Maternal anti-Ro antibody status was documented. Prenatal variables examined included absolute heart (ventricular) rate, change in rate, and development of hydrops fetalis. Postnatally, heart rate, need for pacing, and the indications for pacing were detailed. RESULTS: Of the total of 36 patients, there are 24 survivors; 11 are paced. Of those fetuses which died, two were electively aborted for severe hydrops, seven died in utero, two were immediate postnatal deaths, and one was an unrelated infant death. The trend was for the heart rate to decrease during fetal life and postnatally. Fetuses with deteriorating cardiac function did not always show the lowest heart rates. Bradycardia of less than 55 beats\/min in early pregnancy or rapid decrease in heart rate prenatally were poor prognostic signs. Hydrops was also associated with bad outcome, 10 out of the 12 hydropic fetuses dying (83%). Of 10 fetuses presenting with a heart rate above 60\/min, nine survived of whom three required pacing. Of seven presenting with heart rates of 50\/min or less, only three survived and two of these required pacing. Of the two fetuses with negative maternal anti-Ro antibody status one died in utero and one required heart transplantation after pacemaker insertion. CONCLUSIONS: Isolated complete heart block identified in fetal life does not always have a good prognosis. An individual heart rate does not accurately predict the outcome in utero or the need for postnatal pacing. Regular, careful monitoring during pregnancy is required in order to optimise care and timing of any interventions.<\/jats:p>","DOI":"10.1136\/hrt.75.2.190","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"190-194","source":"Crossref","is-referenced-by-count":147,"title":["Outcome of isolated congenital complete heart block diagnosed in utero."],"prefix":"10.1136","volume":"75","author":[{"given":"A. M.","family":"Groves","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. D.","family":"Allan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1996,2,1]]},"reference":[{"issue":"4","key":"ref_1","first-page":"467","article-title":"Sur un maladie infantile caracterisee par des modifications permanente du pouls, des attaques syncopales et epileptiformes et la mort subite","volume":"1901","author":"Morquio, L.","unstructured":"Morquio L. Sur un maladie infantile caracterisee par des modifications permanente du pouls, des attaques syncopales et epileptiformes et la mort subite. Arch Med Enfants 1901;4:467-75.","journal-title":"Arch Med Enfants"},{"issue":"38","key":"ref_2","first-page":"112","article-title":"Congenital heart block: review of the literature report of a case with incomplete heterotaxy: the electrocardiogram in dextrocardia","volume":"1929","author":"Yater, W.M.","unstructured":"Yater WM. Congenital heart block: review of the literature report of a case with incomplete heterotaxy: the electrocardiogram in dextrocardia. Am Jf Dis Child 1929;38:112-36.","journal-title":"Am Jf Dis Child"},{"key":"ref_3","first-page":"117","article-title":"Complete atrioventricular block in a fetus","volume":"102","author":"Plant, R.K.; Steven, R.A.","year":"1945","unstructured":"Plant RK, Steven RA. Complete atrioventricular block in a fetus. Am Heart_J 1945;102:117-22.","journal-title":"Am Heart_J"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/j.1471-0528.1985.tb03074.x","article-title":"The assessment of persistent bradycardia in prenatal life","volume":"92","author":"Crawford, D.; Chapman, M.; Allan, L.D.","year":"1985","unstructured":"Crawford D, Chapman M, Allan LD. The assessment of persistent bradycardia in prenatal life. Br J Obstet Gynaecol 1985;92:941-4.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/hrt.50.3.240","article-title":"Evaluation of fetal arrhythmias by echocardiography","volume":"50","author":"Allan, L.D.; Anderson, R.H.; Sullivan, I.D.; Campbell, S.; Holt, D.W.; Tynan, M.","year":"1983","unstructured":"Allan LD, Anderson RH, Sullivan ID, Campbell S, Holt DW, Tynan M. Evaluation of fetal arrhythmias by echocardiography. Br HeartJ_ 1983;50:240-5.","journal-title":"Br HeartJ_"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0028-2243(89)90022-1","article-title":"Fetal complete heart block: antenatal diagnosis, significance and management","volume":"31","author":"Gembruch, U.; Hansmann, M.; Redel, D.A.; Bald, R.; Knopfle, G.","year":"1989","unstructured":"Gembruch U, Hansmann M, Redel DA, Bald R, Knopfle G. Fetal complete heart block: antenatal diagnosis, significance and management. Eur J Obst Gynecol 1989;31:9-22.","journal-title":"Eur J Obst Gynecol"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1136\/adc.41.220.688","article-title":"Congenital heart block and widespread fibrosis due to maternal lupus erythematosus","volume":"41","author":"Hull, D.; Binns, B.A.O.; Joyce, D.","year":"1966","unstructured":"Hull D, Binns BAO, Joyce D. Congenital heart block and widespread fibrosis due to maternal lupus erythematosus. Arch Dis Child 1966;41:688-90.","journal-title":"Arch Dis Child"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1161\/01.CIR.56.1.82","article-title":"Congenital heart block in newborns of mothers with connective tissue disease","volume":"56","author":"McCue, C.M.; Mantakas, M.E.; Tingelstad, J.B.; Ruddy, S.","year":"1977","unstructured":"McCue CM, Mantakas ME, Tingelstad JB, Ruddy S. Congenital heart block in newborns of mothers with connective tissue disease. Circulation 1977;56:82-90.","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1056\/NEJM198501103120206","article-title":"Connective tissue disease, antibodies to ribonucleoprotein, and congenital heart block","volume":"312","year":"1985","unstructured":"Scott JS, Maddison PJ, Taylor PV, Esscher E, Scott 0, Skinner RP. Connective tissue disease, antibodies to ribonucleoprotein, and congenital heart block. N Engl J Med 1985;312:98-100.","journal-title":"N Engl J Med"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/0002-9149(71)90410-3","article-title":"Lack of connection between the atria and the more peripheral conduction system in congenital atrioventricular block","volume":"27","author":"Lev, M.; Silverman, J.; Fitzmaurice, F.M.; Paul, M.H.; Cassels, D.E.; Miller, R.A.","year":"1971","unstructured":"Lev M, Silverman J, Fitzmaurice FM, Paul MH, Cassels DE, Miller RA. Lack of connection between the atria and the more peripheral conduction system in congenital atrioventricular block. Am J Cardiol 1971;27:481-90.","journal-title":"Am J Cardiol"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/0735-1097(92)90191-O","article-title":"Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block","volume":"20","author":"Ho, S.Y.; Fagg, N.; Anderson, R.H.; Cook, A.; Allan, L.D.","year":"1992","unstructured":"Ho SY, Fagg N, Anderson RH, Cook A, Allan LD. Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block. J Am Coll Cardiol 1992;20:904-10.","journal-title":"J Am Coll Cardiol"},{"key":"ref_12","first-page":"512","volume-title":"Fetal complete heart block. Br Heartj7","volume":"60","author":"Machado, M.V.L.; Tynan, M.J.; Curry, P.V.L.; Allan, L.D.","year":"1988","unstructured":"Machado MVL, Tynan MJ, Curry PVL, Allan LD. Fetal complete heart block. Br Heartj7 1988;60:512-5."},{"issue":"84-94","key":"ref_13","first-page":"14","article-title":"Ultrasound assessment of cardiac function in the intact human fetus","volume":"5","author":"Kleinman, C.S.; Donnerstein, R.L.","year":"1985","unstructured":"Kleinman CS, Donnerstein RL. Ultrasound assessment of cardiac function in the intact human fetus. JT Am Coll Cardiol 1985;5:84-94S. 14 Serwer GA, Vermillion RP, Snider AR, Dick M, Crowley DC, Hayashi RH. Prognostic indicators for fetuses with in utero diagnosed complete heart block [abstr].","journal-title":"JT Am Coll Cardiol; Prognostic indicators for fetuses with in utero diagnosed complete heart block"},{"key":"ref_14","first-page":"1360","article-title":"Perinatal outcome of fetal complete atrioventricular block: a multicenter experience.3Am Coll","volume":"17","author":"Schmidt, K.G.; Ulmer, H.E.; Silverman, N.H.; Kleinman, C.S.; Copel, J.A.","year":"1991","unstructured":"Schmidt KG, Ulmer HE, Silverman NH, Kleinman CS, Copel JA. Perinatal outcome of fetal complete atrioventricular block: a multicenter experience.3Am Coll Cardiol 1991;17: 1360-6.","journal-title":"Cardiol"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/S0022-3476(88)80231-2","article-title":"Successful management of congenital atrioventricular block associated with hydrops fetalis","volume":"112","author":"Martin, T.C.; Arias, F.; Oglander, D.S.; Hoffman, R.J.; Marburger, J.P.; Maurer, M.M.","year":"1988","unstructured":"Martin TC, Arias F, Oglander DS, Hoffman RJ, Marburger JP, Maurer MM. Successful management of congenital atrioventricular block associated with hydrops fetalis. J Pediatr 1988;112:984-6.","journal-title":"J Pediatr"},{"key":"ref_16","first-page":"17","article-title":"Therapeutic use of inotropes in complete heart block in the fetus [abstr]","volume":"69","author":"Groves, A.M.M.; Allan, L.D.; Rosenthal, E.","year":"1993","unstructured":"Groves AMM, Allan LD, Rosenthal E. Therapeutic use of inotropes in complete heart block in the fetus [abstr]. Br Heartr. 1993;69:17s.","journal-title":"Br Heartr"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1471-0528.1987.tb03107.x","article-title":"Successful pregnancy following steroid therapy and plasma exchange in a woman with anti-Ro (SS-A) antibodies. Case report","volume":"94","author":"Barclay, C.S.; French, M.A.H.; Ross, L.D.; Sokol, R.J.","year":"1987","unstructured":"Barclay CS, French MAH, Ross LD, Sokol RJ. Successful pregnancy following steroid therapy and plasma exchange in a woman with anti-Ro (SS-A) antibodies. Case report. Br J Obstet Gynaecol 1987;94: 369-71.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/S0735-1097(86)80319-9","article-title":"Fetal ventricular pacing for hydrops secondary to complete atrioventricular block","volume":"8","author":"Carpenter, R.J.; Strasburger, J.F.; Garson, A.; Smith, R.T.; Deter, R.L.; Engelhardt, H.T.","year":"1986","unstructured":"Carpenter RJ, Strasburger JF, Garson A, Smith RT, Deter RL, Engelhardt HT. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. J Am Coll Cardiol 1986;8: 1434-6.","journal-title":"J Am Coll Cardiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/0002-8703(89)90009-4","article-title":"Congenital complete heart block in patients without anatomic cardiac defects","volume":"118","author":"Sholler, G.F.; Walsh, E.P.","year":"1989","unstructured":"Sholler GF, Walsh EP. Congenital complete heart block in patients without anatomic cardiac defects. Am Heart J 1989;118:1193-8.","journal-title":"Am Heart J"},{"key":"ref_20","first-page":"85","article-title":"Congenital complete heart block: an international study of the natural history","volume":"4","author":"Michaelsson, M.; Engle, M.A.","year":"1972","unstructured":"Michaelsson M, Engle MA. Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 1972;4:85-101.","journal-title":"Cardiovasc Clin"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJM198704023161403","article-title":"Use of ambulatory electrocardiographic monitoring to identify high-risk patients with congenital complete heart block","volume":"14","author":"Dewey, R.C.; Capeless, M.A.; Levy, A.M.","year":"1987","unstructured":"Dewey RC, Capeless MA, Levy AM. Use of ambulatory electrocardiographic monitoring to identify high-risk patients with congenital complete heart block. N Engl J Med 1987;14:835-9.","journal-title":"N Engl J Med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1542\/peds.69.6.728","article-title":"Diagnosis, management, and long-term results of patients with congenital complete atrioventricular block","volume":"69","author":"Pinskey, W.M.; Gillette, P.C.; Garson, A.; McNamara, D.G.","year":"1982","unstructured":"Pinskey WM, Gillette PC, Garson A, McNamara DG. Diagnosis, management, and long-term results of patients with congenital complete atrioventricular block. Pediatrics 1982;69:728-33.","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/0002-9149(81)90326-X","article-title":"Congenital complete atrioventricular block: clinical and electrophysiologic predictors of need for pacemaker insertion","volume":"48","author":"Karpawich, P.P.; Gillette, P.C.; Garson, A.; Hesslein, P.S.; Porter, C.-B.; Macnamara, D.G.","year":"1981","unstructured":"Karpawich PP, Gillette PC, Garson A, Hesslein PS, Porter C-B, Macnamara DG. Congenital complete atrioventricular block: clinical and electrophysiologic predictors of need for pacemaker insertion. Am J Cardiol 1981;48: 1098-102.","journal-title":"Am J Cardiol"},{"key":"ref_24","first-page":"121","article-title":"Q-T interval in congenital complete heart block","volume-title":"Pediatr Cardiol","volume":"4","author":"Esscher, E.; Michaelsson, M.","year":"1983","unstructured":"Esscher E, Michaelsson M. Q-T interval in congenital complete heart block. Pediatr Cardiol 1983;4: 121-4."}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.75.2.190","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T19:13:53Z","timestamp":1760728433000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.75.2.190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,2]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1996,2,1]]},"published-print":{"date-parts":[[1996,2]]}},"alternative-id":["10.1136\/hrt.75.2.190"],"URL":"https:\/\/doi.org\/10.1136\/hrt.75.2.190","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,2]]}}}