RESEARCH - Electrocardiographic abnormalities in infants born from mothers with autoimmune diseeases

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Rheumatology Advance Access published online on April 20, 2007

Electrocardiographic abnormalities in infants born from mothers with

autoimmune diseases-a multicentre prospective study

M. Gerosa1, R. Cimaz2, M. Stramba-Badiale3, K. Goulene3, E. Meregalli2, L.

Trespidi4, B. Acaia4, R. Cattaneo5, A. Tincani5, M. Motta6, A. Doria7, F.

Zulian8, O. Milanesi8, A. Brucato9, P. Riboldi1,10 and P. L. Meroni1,10

1Allergy, Clinical immunology and Rheumatology Unit IRCCS Istituto

Auxologico Italiano,2Department of Paediatrics, Fondazione Policlinico

Mangiagalli,3Cardiology Unit IRCCS Istituto Auxologico Italiano

and4Department of Obstetrics and Gynaecology, Fondazione Policlinico

Mangiagalli, Milan,5Rheumatology Unit and6Division of Paediatrics, Spedali

Civili and University of Brescia, Brescia,7Division of Rheumatology

and8Department of Pediatrics, University of Padua, Padua and9Division of

Internal Medicine, Niguarda Hospital10Department of Internal Medicine,

University of Milan, Milan, Italy

Abstract

Objectives. To assess the prevalence of congenital heart block (CHB) and

electrocardiographic (ECG) abnormalities in infants of anti-Ro/SSA-positive

women.

Methods. Sixty anti-Ro-positive and 36 anti-Ro-negative patients were

prospectively followed before/during pregnancy and underwent weekly fetal

echocardiography from 18th to 26th weeks of gestational age. Infants' ECG

and/or ECG-Holter were performed at 1, 3, 6 and 12 months. ECG of 200

consecutive neonates were used as a healthy control group.

Results. One of 61 fetuses of anti-Ro-positive mothers developed CHB (20th

week); another anti-Ro-positive baby developed second degree

atrioventricular (AV) block (30th week). The prevalence of transient first

degree AV block detected post-natally was significantly higher in the

anti-Ro-positive group, in comparison with healthy controls (P = 0.002). No

differences in corrected QT (QTc) interval prolongation prevalence (440 ms)

was observed between the anti-Ro-positive and -negative groups, but both

were significantly higher than that of the control population (P < 0.001).

ECG-Holter showed QTc prolongation in 59% of infants of anti-Ro-positive and

in 60% of infants of anti-Ro-negative mothers. Holter QTc was 470 ms in four

infants of anti-Ro-positive group and two of anti-Ro-negative group. Known

acquired causes of QTc prolongation were excluded.

Conclusions. This prospective study confirms the low occurrence of CHB in

newborns from anti-Ro-positive mothers. ECG abnormalities (first degree AV

block and QTc interval prolongation) are frequent in infants of mothers with

autoimmune diseases, independently of maternal disease, autoantibody profile

and treatment during pregnancy.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem073v1?papetoc

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