Pediatric Congenital Atrioventricular Block Medication
- Author: Monesha Gupta, MD, MBBS, FAAP, FACC, FASE; more...
Medication Summary
Intrauterine treatments used for CAVB include chronotropic agents, inotropic agents, steroids, and plasmapheresis. In general, medications are not necessary in children with complete CAVB. Emergency use of chronotropic medications, with or without inotropic agents, may be helpful in fetuses and newborns with hydrops fetalis, congestive heart failure, or low cardiac output.
Some investigators have suggested the use of immunosuppressive agents in fetuses and newborns to potentially slow or halt progressive CAVB in utero. This is currently being evaluated as a prospective study.
The use of steroids or immunoglobulins may be helpful in early first- and second-degree heart block and in reducing associated myocardial dysfunction.
Corticosteroids
Class Summary
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Dexamethasone (Baycadron, Dexamethasone Intensol)
Dexamethasone may produce significant clinical responses in some patients. It may be helpful in early first- and second-degree heart block and in reducing associated myocardial dysfunction.
Blood Products
Class Summary
These agents are used to improve the clinical aspect of the disease. It may reduce associated myocardial dysfunction.
Immune globulin intravenous (Gamunex, Octagam, Gammaplex, Gammagard)
This provides an antibody-mediated blockade of Fas-Fas ligand interactions involved in the epidermal necrosis of toxic epidermal necrolysis–like cutaneous lupus erythematosus.
Michaelsson M, Jonzon A, Riesenfeld T. Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation. Aug 1 1995;92(3):442-9. [Medline]. [Full Text].
Claus R, Hickstein H, Kulz T, et al. Identification and management of fetuses at risk for, or affected by, congenital heart block associated with autoantibodies to SSA (Ro), SSB (La), or an HsEg5-like autoantigen. Rheumatol Int. Aug 2006;26(10):886-95. [Medline].
Costedoat-Chalumeau N, Amoura Z, Villain E, et al. Anti-SSA/Ro antibodies and the heart: more than complete congenital heart block? A review of electrocardiographic and myocardial abnormalities and of treatment options. Arthritis Res Ther. 2005;7(2):69-73. [Medline].
Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, et al. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus. 2005;14(9):660-4. [Medline].
Weng KP, Chiou CW, Huang SH, et al. The long-term outcome of children with isolated congenital complete atrioventricular block. Acta Paediatr Taiwan. Sep-Oct 2005;46(5):260-7. [Medline].
Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol. Jul 2005;26(1):16-21. [Medline].
Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation. 2008;117:485-93. [Medline].
Figa FH, McCrindle BW, Bigras JL, et al. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 1):1902-9. [Medline].
Print
