tetano
Editor, Senior Moderator
Int J Cardiol
. 2020 May 18;S0167-5273(20)32223-3.
doi: 10.1016/j.ijcard.2020.05.036. Online ahead of print.
Arrhythmic Profile and 24-hour QT Interval Variability in COVID-19 Patients Treated With Hydroxychloroquine and Azithromycin
Alberto Cipriani[SUP] 1 [/SUP], Alessandro Zorzi[SUP] 2 [/SUP], Davide Ceccato[SUP] 3 [/SUP], Federico Capone[SUP] 3 [/SUP], Matteo Parolin[SUP] 3 [/SUP], Filippo Donato[SUP] 2 [/SUP], Paola Fioretto[SUP] 3 [/SUP], Raffaele Pesavento[SUP] 3 [/SUP], Lorenzo Previato[SUP] 3 [/SUP], Pietro Maffei[SUP] 3 [/SUP], Alois Saller[SUP] 3 [/SUP], Angelo Avogaro[SUP] 3 [/SUP], Cristiano Sarais[SUP] 2 [/SUP], Dario Gregori[SUP] 2 [/SUP], Sabino Iliceto[SUP] 2 [/SUP], Roberto Vettor[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.
Methods: We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.
Results: Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.
Conclusion: Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.
Keywords: COVID-19; Coronavirus; Severe acute respiratory syndrome; Sudden death; Ventricular arrhythmia.
Copyright ? 2020. Published by Elsevier B.V.
. 2020 May 18;S0167-5273(20)32223-3.
doi: 10.1016/j.ijcard.2020.05.036. Online ahead of print.
Arrhythmic Profile and 24-hour QT Interval Variability in COVID-19 Patients Treated With Hydroxychloroquine and Azithromycin
Alberto Cipriani[SUP] 1 [/SUP], Alessandro Zorzi[SUP] 2 [/SUP], Davide Ceccato[SUP] 3 [/SUP], Federico Capone[SUP] 3 [/SUP], Matteo Parolin[SUP] 3 [/SUP], Filippo Donato[SUP] 2 [/SUP], Paola Fioretto[SUP] 3 [/SUP], Raffaele Pesavento[SUP] 3 [/SUP], Lorenzo Previato[SUP] 3 [/SUP], Pietro Maffei[SUP] 3 [/SUP], Alois Saller[SUP] 3 [/SUP], Angelo Avogaro[SUP] 3 [/SUP], Cristiano Sarais[SUP] 2 [/SUP], Dario Gregori[SUP] 2 [/SUP], Sabino Iliceto[SUP] 2 [/SUP], Roberto Vettor[SUP] 3 [/SUP]
Affiliations
- PMID: 32439366
- DOI: 10.1016/j.ijcard.2020.05.036
Abstract
Background: Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established.
Methods: We performed 12‑lead ECGs and 12‑lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control.
Results: Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability.
Conclusion: Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.
Keywords: COVID-19; Coronavirus; Severe acute respiratory syndrome; Sudden death; Ventricular arrhythmia.
Copyright ? 2020. Published by Elsevier B.V.