QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin
QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin
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DOI：
10.1016/j.hrthm.2020.05.014
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发表时间：
2020-09-01
期刊：
影响因子：
5.5
通讯作者：
Jankelson, Lior
中科院分区：
文献类型：
--
作者：
Chorin, Ehud;Wadhwani, Lalit;Jankelson, Lior
背景对于2019冠状病毒病（COVID-19）患者，目前尚无已知的有效疗法。最初的报道证实了羟氯喹/阿奇霉素（HY/ AZ）的潜在益处，导致这种组合在世界范围内被大量采用。然而，虽然这种疗法的真正疗效尚不清楚，最初的报道已经引起了对QT间期延长和诱导尖端扭转型室性心动过速（TdP）的潜在风险的关注。目的本研究的目的是评估HY/AZ治疗COVID-19患者的校正QT（QTc）间期和心血管事件的变化。方法这是一项回顾性研究，来自2个中心的251例患者，被诊断为COVID-19并接受HY/AZ治疗的患者。我们回顾了从基线到治疗完成后3天的心电图描记，以确定QTc间期的进展以及心律失常和死亡率的发生率。结果QTc间期延长与药物暴露的增加平行，并在其完成后不完全缩短。在23%的患者中出现了极端的新QTc间期延长至0.500 ms，这是TdP高风险的已知标志物。1例患者出现疑似TdP的多形性室性心动过速，需要紧急心脏复律。7例患者需要提前终止治疗。结论HY/AZ联合用药可显著延长COVID-19患者的QTc间期。这种延长可能导致TdP形式的危及生命的心律失常。鉴于HY/AZ治疗的疗效尚未得到证实，这种风险要求仔细考虑HY/AZ治疗。如果给予方案，应进行严格的QTc间期监测。
BACKGROUND There is no known effective therapy for patients with coronavirus disease 2019 (COVID-19). Initial reports suggest-ing the potential benefit of hydroxychloroquine/azithromycin (HY/ AZ) have resulted in massive adoption of this combination world-wide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns about the potential risk of QT in-terval 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 cen-ters 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 prema-ture 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.