Case Report: Right Bundle Brunch Block and QTc Prolongation in a Patient with COVID-19 Treated with Hydroxychloroquine

Asli, Rosmonaliza; Abdullah, Muhammad; Chong, Pui Lin; Metussin, Dhiya; Momin, Riamiza Natalie; Mani, Babu Ivan; Chong, Vui Heng

doi:10.4269/ajtmh.20-0376

Cited by 10 publications

(10 citation statements)

References 8 publications

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“…From the safety point of view, short-term HCQ treatment has been considered safe, even in pregnancy [43]. However, the addition of azithromycin may lead to QT prolongation [44], as well as bundle branch block [45]. Nonetheless, these issues could be tackled with the inpatient use of ambulatory telemetry monitors [46].…”

Section: Discussionmentioning

confidence: 99%

An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

et al. 2020

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Background and ObjectiveThe world is currently experiencing the Coronavirus Disease-19 (COVID-19) pandemic. There is no approved drug for the definitive treatment of the disease. Various drugs are being tried for the treatment of COVID-19, including hydroxychloroquine (HCQ). This study was performed to systematically review the therapeutic role of HCQ in COVID-19 from the available literature. Methods PubMed, Embase, ClinicalTrials.gov, ICTRP (WHO), Cochrane Library databases, and two pre-print servers (medRxiv.org and Research Square) were searched for clinical studies that evaluated the therapeutic role of HCQ on COVID-19 until 10 May 2020. The available studies were critically analyzed and the data were extracted. Results A total of 663 articles were screened and 12 clinical studies (seven peer-reviewed and published studies and five non-peer-reviewed studies from pre-print servers) with a total sample size of 3543 patients were included. Some of the clinical studies demonstrated good virological and clinical outcomes with HCQ alone or in combination with azithromycin in COVID-19 patients, although the studies had major methodological limitations. Some of the other studies showed negative results with HCQ therapy along with the risk of adverse reactions. ConclusionThe results of efficacy and safety of HCQ in COVID-19, as obtained from the clinical studies, are not satisfactory, although many of these studies had major methodological limitations. Stronger evidence from well-designed robust randomized clinical trials is required before conclusively determining the role of HCQ in the treatment of COVID-19. Clinical prudence is required in advocating HCQ as a therapeutic armamentarium in COVID-19. Key PointsEfficacy and safety results obtained from clinical studies on the therapeutic role of HCQ in COVID-19 are not satisfactory.The majority of the published studies have major methodological limitations.Safety aspects associated with the use of HCQ along with azithromycin in COVID-19 warrants caution.Large and robust randomized controlled trials will conclusively determine the role of HCQ in COVID-19.

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Section: Discussionmentioning

confidence: 99%

An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

et al. 2020

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“…We found three case reports of patients with increased QTc or other conduction block arrhythmia in patients with lupus [ [16] , [17] , [18] ] and one in a patient with COVID-19 [ 19 ]. However, in all cases, the patients were successfully treated without any deaths occurring.…”

Section: Resultsmentioning

confidence: 99%

Hydroxychloroquine is protective to the heart, not harmful: a systematic review

Prodromos¹,

Rumschlag²,

Perchyk³

2020

New Microbes and New Infections

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Hydroxychloroquine (HCQ) has been shown to be at least somewhat effective in treating patients with coronavirus disease 2019 (COVID-19). Recently the US Food and Drug Administration and Centers for Disease Control and Prevention warnings of fatal cardiac toxicity from torsades de pointes (TDP) arrhythmia from HCQ receipt have been made, notwithstanding the long safe provision of HCQ to treat lupus and rheumatoid arthritis. This has resulted in restricted access of HCQ for COVID-19 treatment. We hypothesized that HCQ and azithromycin have not been reported to cause significant acute cardiac arrhythmic mortality. We performed a literature search for the effects of HCQ and azithromycin on the heart. No TDP or related deaths were found to have been reported as a result of HCQ and azithromycin receipt in the peer-reviewed literature. On the contrary, HCQ and azithromycin were both found to substantially reduce cardiac mortality and also decrease thrombosis, arrhythmia and cholesterol in treated patients in recent peer-reviewed studies and meeting presentations. HCQ and azithromycin do not cause TDP cardiac mortality; rather, HCQ decreases cardiac events. HCQ should not be restricted in COVID-19 patients out of fear of cardiac mortality.

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“…Additional ECG findings reported in the included studies are sinus bradycardia 19 , sinus tachycardia 26 , sinus pauses in 3 patients 16 , and QT prolongation 24,32,37,40 .…”

Section: Changes In the Type Of Heart Block During The Clinical Coursementioning

confidence: 99%

“…Additional ECG findings reported in the included studies are sinus bradycardia 19 , sinus tachycardia 26 , sinus pauses in 3 patients 16 , and QT prolongation 24,32,37,40 . Pathophysiological, histological, and imaging data 8,43 indicate that SARS-CoV-2 could induce tissue damage, which would predispose patients to recurrent cardiac issues long-term after discharge.…”

Section: Changes In the Type Of Heart Block During The Clinical Coursementioning

confidence: 99%

Heart Block in the Patients with COVID-19

Ahammed

Sharath

Sinha

et al. 2022

Preprint

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Background: Since the emergence of the SARS COV-19 pandemic, multiple extrapulmonary manifestations of the virus have been reported from around the world. Cardiovascular complications including arrhythmias in patients with COVID-19 have been described in multiple studies. Our aim was to review various case reports detailing the new onset of heart block in COVID-19 patients and to summarise the clinical course of these patients. Methods: We systematically reviewed all reports published and indexed in PubMed, Scopus, and Embase between March 2020 to May 2021, analyzing the relation between the demographics of the patients, pre-existing comorbidities, and the progression of heart block in patients infected with COVID-19. Results: We identified and included in this study 30 relevant articles describing 49 COVID-19 patients with heart block. Among them, 69.3% (n=34) of patients suffered from at least one comorbidity. 36.73% (n=18) of the patients showed spontaneous resolution of the heart block. Conversely, 63.26% (n=31) of the patients had persistent heart block, out of which 16.33% (n=8) and 42.86% (n=21) were implanted with a temporary and permanent pacemaker respectively. The reported mortality rate was 22.45% (n=11) during hospitalization. We noted that 45.45% (n=5) of the patients who died had complete heart block. 24.49% (n=12) of the patients in the studies we reviewed were suspected of having myocarditis. However, none were confirmed with MRI or cardiac biopsy. Conclusions: Additional research is necessary to unearth the mechanism of development of heart block in COVID-19 patients as well as its implications on the clinical course and prognosis. Physicians must be aware of the importance of monitoring patients hospitalized for COVID-19 for arrhythmias including heart blocks, especially in the presence of comorbidities. Early detection can improve the prognosis of the patient.

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Case Report: Right Bundle Brunch Block and QTc Prolongation in a Patient with COVID-19 Treated with Hydroxychloroquine

Cited by 10 publications

References 8 publications

An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19)

Hydroxychloroquine is protective to the heart, not harmful: a systematic review

Heart Block in the Patients with COVID-19

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