QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin.
Aged
Anti-Bacterial Agents
/ therapeutic use
Antimalarials
/ therapeutic use
Azithromycin
/ therapeutic use
Betacoronavirus
COVID-19
Coronavirus Infections
/ complications
Female
Humans
Hydroxychloroquine
/ therapeutic use
Incidence
Long QT Syndrome
/ epidemiology
Male
Middle Aged
Pandemics
Pneumonia, Viral
/ drug therapy
Retrospective Studies
SARS-CoV-2
Torsades de Pointes
/ epidemiology
COVID-19 Drug Treatment
Azithromycin
COVID-19
Hydroxychloroquine
QT interval
Torsade de pointes
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
15
5
2020
medline:
10
9
2020
entrez:
15
5
2020
Statut:
ppublish
Résumé
There is no known effective therapy for patients with coronavirus disease 2019 (COVID-19). Initial reports suggesting the potential benefit of hydroxychloroquine/azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns about the potential risk of QT interval prolongation and induction of torsade de pointes (TdP). The purpose of this study was to assess the change in corrected QT (QTc) interval and arrhythmic events in patients with COVID-19 treated with HY/AZ. This is a retrospective study of 251 patients from 2 centers who were diagnosed with COVID-19 and treated with HY/AZ. We reviewed electrocardiographic tracings from baseline and until 3 days after the completion of therapy to determine the progression of QTc interval and the incidence of arrhythmia and mortality. The QTc interval prolonged in parallel with increasing drug exposure and incompletely shortened after its completion. Extreme new QTc interval prolongation to >500 ms, a known marker of high risk of TdP, had developed in 23% of patients. One patient developed polymorphic ventricular tachycardia suspected as TdP, requiring emergent cardioversion. Seven patients required premature termination of therapy. The baseline QTc interval of patients exhibiting extreme QTc interval prolongation was normal. The combination of HY/AZ significantly prolongs the QTc interval in patients with COVID-19. This prolongation may be responsible for life-threatening arrhythmia in the form of TdP. This risk mandates careful consideration of HY/AZ therapy in light of its unproven efficacy. Strict QTc interval monitoring should be performed if the regimen is given.
Sections du résumé
Background
There is no known effective therapy for patients with coronavirus disease 2019 (COVID-19). Initial reports suggesting the potential benefit of hydroxychloroquine/azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns about the potential risk of QT interval prolongation and induction of torsade de pointes (TdP).
Objective
The purpose of this study was to assess the change in corrected QT (QTc) interval and arrhythmic events in patients with COVID-19 treated with HY/AZ.
Methods
This is a retrospective study of 251 patients from 2 centers who were diagnosed with COVID-19 and treated with HY/AZ. We reviewed electrocardiographic tracings from baseline and until 3 days after the completion of therapy to determine the progression of QTc interval and the incidence of arrhythmia and mortality.
Results
The QTc interval prolonged in parallel with increasing drug exposure and incompletely shortened after its completion. Extreme new QTc interval prolongation to >500 ms, a known marker of high risk of TdP, had developed in 23% of patients. One patient developed polymorphic ventricular tachycardia suspected as TdP, requiring emergent cardioversion. Seven patients required premature termination of therapy. The baseline QTc interval of patients exhibiting extreme QTc interval prolongation was normal.
Conclusion
The combination of HY/AZ significantly prolongs the QTc interval in patients with COVID-19. This prolongation may be responsible for life-threatening arrhythmia in the form of TdP. This risk mandates careful consideration of HY/AZ therapy in light of its unproven efficacy. Strict QTc interval monitoring should be performed if the regimen is given.
Identifiants
pubmed: 32407884
pii: S1547-5271(20)30435-5
doi: 10.1016/j.hrthm.2020.05.014
pmc: PMC7214283
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Antimalarials
0
Hydroxychloroquine
4QWG6N8QKH
Azithromycin
83905-01-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1425-1433Informations de copyright
© 2020 Heart Rhythm Society. All rights reserved.
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