Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus

BACKGROUND

Cardiac manifestations of neonatal lupus include conduction disease and, rarely, an isolated cardiomyopathy. This study was initiated to determine the mortality and morbidity of cardiac neonatal lupus and associated risk factors in a multi-racial/ethnic US-based registry to provide insights into the pathogenesis of antibody-mediated injury and data for counseling.

METHODS AND RESULTS

Three hundred twenty-five offspring exposed to maternal anti-SSA/Ro antibodies with cardiac neonatal lupus met entry criteria. Maternal, fetal echocardiographic, and neonatal risk factors were assessed for association with mortality. Fifty-seven (17.5%) died, 30% in utero. The probability of in utero death was 6%. The cumulative probability of survival at 10 years for a child born alive was 86%. Fetal echocardiographic risk factors associated with increased mortality in a multivariable analysis of all cases included hydrops and endocardial fibroelastosis. Significant predictors of in utero death were hydrops and earlier diagnosis, and of postnatal death were hydrops, endocardial fibroelastosis, and lower ventricular rate. Isolated heart block was associated with a 7.8% case fatality rate, whereas the concomitant presence of dilated cardiomyopathy or endocardial fibroelastosis quadrupled the case fatality rate. There was a significantly higher case fatality rate in minorities compared with whites, who were at a lower risk of hydrops and endocardial fibroelastosis. Pacing was required in 70%; cardiac transplantation was required in 4 children.

CONCLUSION

Nearly one fifth of fetuses who develop cardiac neonatal lupus die of complications predicted by echocardiographic abnormalities consistent with antibody-associated disease beyond the atrioventricular node. The disparity in outcomes observed between minorities and whites warrants further investigation.

Effects of race and health insurance on the rates of pacemaker implantation for complete heart block in the United States

Although indicated for adults with complete heart block, pacemaker implantation is not always practiced. There are gross discrepancies by race, type of health insurance coverage, and size of hospital of admission in the utilization of pacemakers.

Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III

BACKGROUND

Electrocardiographic (ECG) differences occur between African-American and Caucasian patients.

METHODS

The study includes ECGs of 2,123 patients, ages 20-99 years attending an urban hospital.

RESULTS

First-degree atrioventricular (AV) block was more prevalent in African-American patients compared with Caucasian patients in all age groups of the study except for those patients in the eighth decade of life. The prevalence of first-degree AV block began to increase at age 50 years in both ethnic groups and gradually increased with advancing age, peaking in African-American patients in the 10th decade of life, and in Caucasian patients in the ninth decade of life. The continuing increase in first-degree AV block in African-American patients in the 10th decade of life suggests increasing impairment but greater durability of the AV conduction system in African-American compared with Caucasian patients. The dramatic decline of the prevalence of first-degree AV block in Caucasian patients in the 10th decade of life suggests more frequent failure of the AV conduction system in this group of patients at ages 90-99 years, compared with African-American patients in the same age group. In population-based surveys, first-degree AV block was more prevalent in African-American subjects compared with Caucasian subjects.

Lower prevalence of intraventricular block in African-American patients compared with Caucasian patients: an electrocardiographic study II

BACKGROUND

Electrocardiographic (ECG) differences occur between African-American and white persons.

METHODS

Intraventricular conduction abnormalities of ECGs of 2,123 African-American and white hospital patients ages 20-99 years were studied in a consecutive manner.

RESULTS

Intraventricular conduction abnormalities develop later in life and are less common in African-American patients, compared with white patients. The prevalence of conduction abnormalities increases with advancing age in both races. Left- and right ventricular conduction abnormalities begin to rise at age 50 for white patients but begin to rise at age 70 for African-American patients. The prevalence of left ventricular conduction abnormalities peaks in the ninth decade of life in both races but declines in both races in the tenth decade of life. The prevalence of right ventricular conduction abnormalities gradually increases and peaks in the tenth decade of life in both races.

CONCLUSIONS

The prevalence of intraventricular block is significantly less in African-American patients, compared with white patients--occurring in 8.6% of African-American patients and in 15.2% of white patients. The prevalence of intraventricular block is lowest in African-American women at 6.5% and highest in white men at 16.8%.

Incidence of cardiac sarcoidosis in Japanese patients with high-degree atrioventricular block

In Japan the majority of sarcoidosis-related deaths are due to cardiac sarcoidosis. One of the most common electrocardiographic abnormalities in patients with this disease is atrioventricular block. This study surveyed the incidence of cardiac sarcoidosis in Japanese patients (40 men and 49 women; mean age, 69.1 years) with high-degree atrioventricular block who were admitted to the hospital to receive a permanent pacemaker. We excluded cases in which sarcoidosis had been diagnosed from the involvement of other organs. Patients with the characteristic signs of sarcoidosis underwent echocardiography, radionuclide imaging, and biopsy. Ten cases (11.2%) of cardiac sarcoidosis were diagnosed, most frequently in women aged 40 to 69 years (8 of 25, 32%). Thus the possibility of cardiac sarcoidosis should be carefully considered in middle-aged or elderly Japanese women who show high-degree atrioventricular block.

Complete heart block in an Inuit family

An Inuit family from Cape Dorset, Northwest Territories is described; six had documented complete heart block, one high grade atrioventricular block, one bi- or trifascicular block and all suffered syncope. One other member received a pacemaker for unknown reasons. Two of three middle-aged relatives had minor conduction abnormalities. All younger family members who were examined had no conduction problems. This suggests a heritable form of adult onset complete heart block, the largest series reported in the English literature.