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PubMed2005

Increased risk of complete congenital heart block in infants born to women with hypothyroidism and anti-Ro and/or anti-La antibodies.

OBJECTIVE: To determine whether the presence of hypothyroidism is associated with an increased incidence of neonatal lupus erythematosus (NLE) in infants of mothers with anti-Ro autoantibodies. METHODS: The cohort consisted of 87 women with anti-Ro antibodies who delivered 102 infants. All infants had a full history and physical examination within 12 weeks of birth, electrocardiogram (echocardiogram when clinically indicated), complete blood cell count with differential, liver function tests, and autoantibody profile. Nine women had hypothyroidism and 78 had normal thyroid function. RESULTS: At least one manifestation of NLE was seen in 7/9 (78%) infants born to mothers with hypothyroidism and 45/78 (58%) infants born to mothers with normal thyroid function. Complete congenital heart block (CCHB) was seen in 5/9 (55%) in the hypothyroid group and 10/78 (13%) of the normal thyroid function group (p < 0.005). Mothers with hypothyroidism had a 9-fold increased risk over women with normal thyroid function of having a child with CCHB (odds ratio 8.63). Twenty-seven (31%) of the women were healthy: 4/9 of the hypothyroid and 23/78 of the normal thyroid function group. Of the 23 infants born to healthy mothers with normal thyroid function, 15/23 (65%) had NLE and 8/23 (35%) of these had CCHB. CONCLUSION: Women with hypothyroidism and anti-Ro antibodies were at increased risk for delivering a child with CCHB compared to women with antibodies alone, irrespective of maternal health. This study indicates that women with hypothyroidism should be tested for anti-Ro antibodies, as they may be at risk to deliver a child with CCHB.

Adult↗
PubMed1994

DDD vs. VVI pacing in patients aged over 75 years with complete heart block: a double-blind crossover comparison.

We studied 16 patients aged 77-88 years to determine whether elderly patients gain significant benefit from dual-chamber (DDD) compared with single-chamber ventricular demand (VVI) pacing. The study was designed as a double-blind randomized two-period crossover study--each pacing mode was maintained for 7 days. End points included: (i) overall symptoms scores; (ii) exercise tests related to daily activities; and (iii) perceived level of difficulty (Borg score). The mean symptom score in DDD mode was 7.07 (6.38) vs. 12.27 (7.29) in VVI mode (p < 0.006). Dizziness, breathlessness and fatigue were the most noticed symptoms during VVI pacing. One patient dropped out from follow-up and three patients requested early reprogramming, all from VVI mode. Overall, no patient preferred VVI mode, 11 preferred DDD mode and four expressed no preference. There were significant improvements in all objective test performances in DDD mode. Mean (SD) total Borg scores in DDD mode and VVI mode were 36.57 (5.85) and 41.93 (6.49), respectively (p < 0.002). Ventricular demand pacing in elderly patients with complete heart block is associated with higher symptom scores, reduced exercise ability and greater perceived exercise difficulty compared with dual-chamber pacing.

Aged↗
PubMed1990

A case-control study of congenital heart block: association with maternal antibodies to Ro(SS-A) and La(SS-B).

A case control study of congenital complete heart block (CHB) was undertaken to determine the degree of association of this condition with maternal connective tissue disease and with maternal autoantibodies, in particular those to Ro(SS-A). Mothers of cases (n = 18) and controls (n = 72) completed a self-administered questionnaire and donated 10 ml of blood. The odds of giving birth to a child with CHB were increased by a factor of 22 for women with antibodies to Ro(SS-A) and/or La(SS-B) compared with women who did not have these antibodies. Thus the association between CHB and both anti-Ro(SS-A) and anti-La(SS-B) antibodies has been demonstrated in an Australian population and indicates that anti-La(SS-B), as well as anti-Ro(SS-A) antibodies may be a risk factor for the development of CHB.

Adolescent↗