Prenatal diagnosis of fetal bradyarrhythmia and postnatal outcome

Prenatal diagnosis of Fetal bradyarrhythmia leads to parental and care provider anxiety as data on outcome is scarce. We aimed to correlate the prenatal presentation of fetal bradyarrhythmia with postnatal outcome.

Retrospective analysis of case records from 2017 to 2021. All fetuses with sustained bradyarrhythmia beyond 11 weeks were included in the study.

Twenty fetuses were identified: mean gestational age at diagnosis was 23 weeks 2 days. The type of bradyarrhythmia was as follows: Complete atrioventricular block 10 (50 %), Sinus Bradycardia 7 (35 %), second degree atrioventricular block 2 (10 %), and Unclassified 1 (5 %). In 10 fetuses, cardiac and extracardiac anatomy were normal; 8 fetuses (40 %) had cardiac anomalies,1 fetus had intraventricular hemorrhage and 1 had nuchal cystic hygroma. Among the fetuses with associated anomalies, there were 5 terminations of pregnancy (TOP), 1 intrauterine fetal demise (IUD), 3 neonatal demise (NND) and 1 livebirth. Among fetuses with normal anatomy, there were 2 TOP and 8 livebirths; five of the 10 mothers (50 %) tested positive for Anti Ro/La antibodies. All the 6 liveborn fetuses with complete atrioventricular block are on conservative management: 2 on metaproterenol and 4 on clinical follow up. Nine out of the 10 cases that had a postnatal paediatric cardiology assessment had a correct prenatal diagnosis.

Correct prenatal identification of fetal bradyarrhythmia is feasible in about 90 % of cases. The risk of postnatal pacemaker requirement appears to be low irrespective of maternal Anti Ro/La status.