Background: Fetal autoimmune atrioventricular block (AVB) is a rare but severe manifestation of cardiac neonatal lupus, primarily caused by maternal anti-SSA/Ro and anti-SSB/La antibodies crossing the placenta. Second-degree type II AVB often progresses rapidly to complete AVB with high mortality, and few cases demonstrate reversal. Case Presentation: We report a 33-year-old Asian woman with systemic lupus erythematosus (SLE) and positive anti-SSA/Ro and anti-SSB/La antibodies whose fetus developed second-degree type II AVB at 23 weeks + 3 days gestation. Combined therapy with hydroxychloroquine, dexamethasone, intravenous immunoglobulin (IVIG), and heparin, along with calcium and vitamin D supplementation, resulted in restoration of normal fetal atrioventricular conduction. Serial fetal echocardiography and maternal antibody monitoring documented gradual reversal. The treatment course was complicated by borderline oligohydramnios and fetal growth restriction, which were managed with dose adjustments and close monitoring. Conclusions: This case illustrates that fetal autoimmune AVB may possess a reversible stage if detected early and managed with individualized immunomodulatory therapy. It emphasizes the importance of early diagnosis, serial echocardiographic monitoring, and multidisciplinary management in high risk pregnancies.