Transient neonatal bradycardia without heart block associated with anti-Ro antibodies

Cimaz, Rolando; Airoldi, ML; Careddu, P; Centinaio, Giovanna; Catelli, Luca; Franceschini, Franco; Meroni, P

doi:10.1177/096120339700600516

Cited by 21 publications

(12 citation statements)

References 5 publications

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“…We observed similar findings in humans [13,42]. In four infants, a significant transient sinus bradycardia was observed (heart rate <3°c entile for age).…”

Section: Sinus Bradycardiasupporting

confidence: 87%

Arrhythmias Presenting in Neonatal Lupus

Brucato

Previtali

Ramoni

et al. 2010

Scandinavian Journal of Immunology

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Arrhythmogenicity and electrophysiological effects of anti-Ro ⁄ SSA antibodiesBased on the facts that there is no convincing evidence that maternal antibodies can cross the sarcolemma of a normal cardiac myocyte, essentially two major categories of mechanisms for congenital complete heart block (CHB) can be identified. The first is abnormal surface expression of intracellular SSA ⁄ Ro and SSB ⁄ La antigens, eventually induced by apoptosis [1, 2], viral infection [3], UV light and IFNc treatment [4]. The other mechanism is the cross-reactivity of maternal antibodies with targets other than SSA ⁄ Ro and SSB ⁄ La antigens. Maternal antibodies were reported to cross-react with laminin and with human cardiac myosin heavy chain at a critical stage during foetal cardiac development [5,6], but the L-type calcium channels seem particularly important in this hypothesis [7][8][9][10].After preliminary reports, [11,12] Boutjdir in an outstanding paper [7] showed that IgG-enriched fractions and anti-52-kD SSA ⁄ Ro antibodies affinity-purified from the sera of mothers whose children have CHB reversibly induce complete atrioventricular (AV) block in the human foetal heart perfused by the Langendorff technique. At 33 min of perfusion, complete AV block was observed with the presence of only P waves and missing QRS complexes. Reperfusion of the heart with antibodyfree Tyrode's solution for 48 min resulted in partial and slow recovery. Superfusion of hearts with IgG fractions from mothers with affected children also induced bradycardia and AV dissociation. In contrast, IgG from control mothers did not have any measurable effect on AV conduction. In the same paper, the authors showed that anti-Ro ⁄ SSA antibodies inhibit L-type Ca 2+ currents at the whole-cell and single-channel level. Immunization of female BALB ⁄ c mice with recombinant 52-kD SSA ⁄ Ro protein generated high-titre antibodies that crossed the placenta during pregnancy and were associated with varying degrees of AV conduction abnormalities, including complete AV block, in the pups. These findings suggest that anti-52-kD SSA ⁄ Ro antibodies are causally related to the development of CHB.The same group reported that the passive transfer of human anti-Ro/SSA into pregnant mice induced AbstractPerfusion of human foetal heart with anti-Ro ⁄ SSA antibodies induces transient heart block. Anti-Ro ⁄ SSA antibodies may cross-react with T-and L-type calcium channels, and anti-p200 antibodies may cause calcium to accumulate in rat heart cells. These actions may explain a direct electrophysiological effect of these antibodies. Congenital complete heart block is the more severe manifestation of so-called ''Neonatal Lupus''. In clinical practice, it is important to distinguish in utero complete versus incomplete atrioventricular (AV) block, as complete AV block to date is irreversible, while incomplete AV block has been shown to be potentially reversible after fluorinated steroid therapy. Another issue is the definition of congenital AV block, as cardiologists have considered co...

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“…We observed similar findings in humans [13,42]. In four infants, a significant transient sinus bradycardia was observed (heart rate <3°c entile for age).…”

Section: Sinus Bradycardiasupporting

confidence: 87%

Arrhythmias Presenting in Neonatal Lupus

Brucato

Previtali

Ramoni

et al. 2010

Scandinavian Journal of Immunology

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show abstract

“…We have recently reported other electrophysiologic abnormalities, such as unexplained bradycardia (1,2) and QT interval prolongation, seen on electrocardiogram (EKG) (3). Since this latter finding can represent a risk for life-threatening arrhythmias (4,5), the aim of the present study was to monitor our patients for 1 year, in order to evaluate the relationship between EKG abnormalities and the presence or disappearance of autoantibodies from the babies' circulation.…”

mentioning

confidence: 93%

Concomitant disappearance of electrocardiographic abnormalities and of acquired maternal autoantibodies during the first year of life in infants who had QT interval prolongation and anti‐SSA/Ro positivity without congenital heart block at birth

Cimaz¹,

Meroni²,

Brucato³

et al. 2003

Arthritis & Rheumatism

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“…It is probable that some infants presenting ECG abnormalities and included in the above-mentioned studies were born from mothers taking HCQ during gestation, although such possibility was not specified by the authors. [11][12][13][14][15][16]27 In our study, on the whole, nine infants showed ECG abnormalities at birth (four AVB, four QT prolongations and one AVB with QT prolongation); of these infants, two with the AVBs were born from anti-SSA/Ropositive mothers taking HCQ during pregnancy. The remaining seven infants with conduction disturbances were from mothers not treated with HCQ, five with and two without anti-SSA/Ro antibodies.…”

Section: Discussionmentioning

confidence: 54%

“…9,10 In addition, electrocardiographic abnormalities, such as sinus bradycardia and prolongation of the corrected QT (QTc) interval, have been described. [11][12][13][14][15] Moreover, anti-SSA/Ro-positive pregnant women frequently carry fetuses with Doppler echocardiographic signs of first-degree atrioventricular block (AVB), that show the tendency to revert spontaneously in the majority of fetuses, although in a few cases they may persist until birth. [16][17][18] The frequency of these alterations is not yet known.…”

Section: Introductionmentioning

confidence: 99%