Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID-19
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Date
2021
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Abstract
Background: Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods: This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. Results: Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 ± 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P <.001). However, HCQ + AZM combination group had significantly higher ΔQTc compared to HCQ group (22.5 ± 18.4 vs 7.5 ± 15.3 ms, P <.001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. Conclusions: The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19. © 2020 John Wiley & Sons Ltd
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Adult , Aged , Anti-Bacterial Agents , Arrhythmias, Cardiac , Azithromycin , Comorbidity , COVID-19 , Drug Therapy, Combination , Electrocardiography , Female , Humans , Hydroxychloroquine , Long QT Syndrome , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , azithromycin , hydroxychloroquine , antiinfective agent , azithromycin , hydroxychloroquine , adult , aging , Article , cohort analysis , comorbidity , comparative study , coronavirus disease 2019 , disease association , drug safety , electronic medical record , female , heart ventricle arrhythmia , hospital mortality , hospitalization , human , incidence , major clinical study , male , middle aged , monotherapy , observational study , priority journal , QT interval , QT prolongation , QTc interval , retrospective study , aged , combination drug therapy , electrocardiography , heart arrhythmia , long QT syndrome