Atrial flutter in a fetus with immune-mediated complete heart block

What is it about?

Circulating maternal anti-Ro antibodies can cross the placenta after 16 weeks of gestation and damage the cardiomyocytes and the conducting system leading to myocarditis and fetal arrhythmias. The commonest arrhythmia seen with anti-Ro antibodies is complete heart block, although varying degrees of atrioventricular block and rarely, fetal tachycardias have been described. We describe the echocardiographic diagnosis and management of a fetus with anti-Ro mediated complete heart block who developed atrial flutter in the third trimester. In utero management of atrial flutter on a background of complete heart block is challenging as anti-arrhythmic agents may cause further bradycardia, but with a non-aggressive approach to treatment of atrial flutter a good outcome was achieved.

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