QT interval and arrhythmic safety of hydroxychloroquine monotherapy in coronavirus disease 2019.
Coronavirus
Electrocardiogram
Hydroxychloroquine
QT interval
Ventricular arrhythmia
Journal
Heart rhythm O2
ISSN: 2666-5018
Titre abrégé: Heart Rhythm O2
Pays: United States
ID NLM: 101768511
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
entrez:
25
8
2020
pubmed:
25
8
2020
medline:
25
8
2020
Statut:
ppublish
Résumé
Observational studies have suggested increased arrhythmic and cardiovascular risk with the combination use of hydroxychloroquine (HCQ) and azithromycin in patients with coronavirus disease 2019 (COVID-19). The arrhythmic safety profile of HCQ monotherapy, which remains under investigation as a therapeutic and prophylactic agent in COVID-19, is less established and we sought to evaluate this. In 245 consecutive patients with COVID-19 admitted to the University of Washington hospital system between March 9, 2020, and May 10, 2020, we identified 111 treated with HCQ monotherapy. Patients treated with HCQ underwent a systematic arrhythmia and QT interval surveillance protocol including serial electrocardiograms (ECG) (baseline, following second HCQ dose). The primary endpoint was in-hospital sustained ventricular arrhythmia or arrhythmic cardiac arrest. Secondary endpoints included clinically significant QTc prolongation. A total of 111 patients with COVID-19 underwent treatment with HCQ monotherapy (mean age 62 ± 16 years, 44 women [39%], serum creatinine 0.9 [interquartile range 0.4] mg/dL). There were no instances of sustained ventricular arrythmia or arrhythmic cardiac arrest. In 75 patients with serial ECGs, clinically significant corrected QT (QTc) prolongation was observed in a minority (n = 5 [7%]). In patients with serial ECGs, there was no significant change in the QTc interval in prespecified subgroups of interest, including those with prevalent cardiovascular disease or baseline use of renin-angiotensin-aldosterone axis inhibitors. In the context of a systematic monitoring protocol, HCQ monotherapy in hospitalized COVID-19 patients was not associated with malignant ventricular arrhythmia. A minority of patients demonstrated clinically significant QTc prolongation during HCQ therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Observational studies have suggested increased arrhythmic and cardiovascular risk with the combination use of hydroxychloroquine (HCQ) and azithromycin in patients with coronavirus disease 2019 (COVID-19).
OBJECTIVE
OBJECTIVE
The arrhythmic safety profile of HCQ monotherapy, which remains under investigation as a therapeutic and prophylactic agent in COVID-19, is less established and we sought to evaluate this.
METHODS
METHODS
In 245 consecutive patients with COVID-19 admitted to the University of Washington hospital system between March 9, 2020, and May 10, 2020, we identified 111 treated with HCQ monotherapy. Patients treated with HCQ underwent a systematic arrhythmia and QT interval surveillance protocol including serial electrocardiograms (ECG) (baseline, following second HCQ dose). The primary endpoint was in-hospital sustained ventricular arrhythmia or arrhythmic cardiac arrest. Secondary endpoints included clinically significant QTc prolongation.
RESULTS
RESULTS
A total of 111 patients with COVID-19 underwent treatment with HCQ monotherapy (mean age 62 ± 16 years, 44 women [39%], serum creatinine 0.9 [interquartile range 0.4] mg/dL). There were no instances of sustained ventricular arrythmia or arrhythmic cardiac arrest. In 75 patients with serial ECGs, clinically significant corrected QT (QTc) prolongation was observed in a minority (n = 5 [7%]). In patients with serial ECGs, there was no significant change in the QTc interval in prespecified subgroups of interest, including those with prevalent cardiovascular disease or baseline use of renin-angiotensin-aldosterone axis inhibitors.
CONCLUSIONS
CONCLUSIONS
In the context of a systematic monitoring protocol, HCQ monotherapy in hospitalized COVID-19 patients was not associated with malignant ventricular arrhythmia. A minority of patients demonstrated clinically significant QTc prolongation during HCQ therapy.
Identifiants
pubmed: 32835316
doi: 10.1016/j.hroo.2020.06.002
pii: S2666-5018(20)30075-1
pmc: PMC7289101
doi:
Types de publication
Journal Article
Langues
eng
Pagination
167-172Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2020 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
Références
J Electrocardiol. 2004;37 Suppl:81-90
pubmed: 15534815
Mayo Clin Proc. 2020 Jun;95(6):1213-1221
pubmed: 32359771
Am J Trop Med Hyg. 2020 Jun;102(6):1184-1188
pubmed: 32323646
JAMA Cardiol. 2020 Sep 1;5(9):1067-1069
pubmed: 32936266
JAMA. 2020 Jun 23;323(24):2493-2502
pubmed: 32392282
N Engl J Med. 2020 Feb 20;382(8):692-694
pubmed: 31978293
N Engl J Med. 2020 Jun 18;382(25):2411-2418
pubmed: 32379955
Circulation. 2010 Mar 2;121(8):1047-60
pubmed: 20142454
Neth Heart J. 2020 Jul;28(7-8):406-409
pubmed: 32350818
Heart Rhythm. 2016 Feb;13(2):527-35
pubmed: 26552754
Clin Infect Dis. 2020 Jul 28;71(15):732-739
pubmed: 32150618
Clin Toxicol (Phila). 2006;44(2):173-5
pubmed: 16615675
JAMA Cardiol. 2020 Sep 01;5(9):1036-1041
pubmed: 32936252
Travel Med Infect Dis. 2020 May - Jun;35:101735
pubmed: 32387694
Circ Arrhythm Electrophysiol. 2020 Jun;13(6):e008662
pubmed: 32347743