Most screenings for fetal congenital heart block do not occur by recommended time
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PHILADELPHIA – In anti-Ro/La-positive pregnancies, most fetal echocardiography screenings for congenital heart block fail to occur by the recommended time, according to data presented at ACR Convergence 2022.
“The most vulnerable period for congenital heart block to develop is between 18 and 24 weeks,” Amanda Ohayon, a graduate student at McGill University Health Center, in Montreal, said during a press conference at the meeting. “To our knowledge, there is no other study that has assessed if congenital heart block detection by fetal echocardiography was being performed according to these guidelines.”
To investigate the timing of congenital heart block screening and detection of conditions in anti-Ro/La pregnancies, Ohayon and colleagues conducted a retrospective data review. Researchers identified every pregnancy that went through an echocardiogram for congenital heart block screening between 2013 and 2021 at the McGill University Health Center. Cases of congenital heart block diagnosis were also included in the analysis. Patients were included in the review if they had anti-Ro/La antibodies present.
The researchers estimated gestational age at the times of the first and last tests in patients referred for congenital heart block screening, using the recorded date of the last menstrual period. In addition, in cases where congenital heart block was detected, by way of screening or otherwise, the gestational age at the time of detection was determined.
The analysis included 44 pregnancies, of which three were twins. Of those, 98% had anti-Ro and 39% had anti-La exposure. The average gestational age at the time of the first echocardiogram was 20.4 weeks. In total, 32% of echocardiograms were performed at or before 18 weeks, 55% were performed before 20 weeks and 91% performed before 22 weeks, according to the researchers. Congenital heart block was detected in three pregnancies. In all three cases, heart block was detected during the first echocardiogram.
Additionally, echocardiograms were performed on two other fetuses referred following incidental bradycardia discoveries in those patients. Four fetuses with congenital heart blocks maintained a third degree atrioventricular block throughout the duration of the pregnancy, according to the researchers.
“These findings should prompt clinicians to adhere to the current guidelines, but also revisit their practice to discover if this same care gap is occurring at their institution,” Ohayon said. “I emphasize that the next steps would be to investigate what are the barriers for timely screenings in order to establish improvement strategies.”
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Ohayon A. Abstract 0957. Presented at: ACR Convergence 2022; Nov. 11-15, 2021; Philadelphia (hybrid meeting).
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