Suspected Hydroxychloroquine-Induced Sinus Bradycardia and QTc Prolongation in a Patient with COVID-19

Kang, Yu; Wang, Hui; Chen, Hong; Wang, Bo; Yang, Ying‐Ying; Zhao, Xuan; Qihui, Ran; Wei, Jiafu

doi:10.1536/ihj.20-271

Cited by 10 publications

(8 citation statements)

References 6 publications

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“…Fourth, we observed that heart rate showed a tendency to bradycardia. Sinus bradycardia is common and paradoxical in COVID-19 [ 38 , 39 , 40 ] and have been related to favipiravir [ 41 ], SIADH [ 42 ], hydroxychloroquine [ 43 ], remdesivir [ 44 , 45 ], lopinavir–ritonavir [ 46 ], among other multiple explanations. It is interpreted that it may be another indirect evidence of abnormal hypervolemia, which generates an increase in preload and, by Frank Starling’s law, increase in stroke volume, resulting in a cardiac adaptive response, with a decrease in heart rate.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

Santos¹,

Zanardi²,

Alo³

et al. 2021

JCM

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In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

Santos¹,

Zanardi²,

Alo³

et al. 2021

JCM

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“…A total of 26 articles reporting cases related to the safety of HCQ or CQ during treatment for COVID-19 were found [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 ]. Table 6 synthesises the data from the cases reporting HCQ and CQ adverse drug reactions in COVID-19-affected patients and Table S21 of Supplementary Material part 2 provides full details.…”

Section: Resultsmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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Section: Resultsmentioning

confidence: 99%

“…Table 2 presents the baseline demographics, diagnostic findings, and chief features of COVID‐19 patients who developed bradycardia from the individual cases compiled ( n = 59). 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 Bradycardia predominated in male patients ( n = 37) with a median age of 58.0 years old (IQR 48.0−71.0). Bradycardia was most often observed in patients classified as having severe or critical illness COVID‐19 (35.6% and 32.2%, respectively).…”

Section: Resultsmentioning

confidence: 99%

Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

Nagamine

Randhawa

Nishimura

et al. 2022

Pacing Clinical Electrophis

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COVID-19 has recently been associated with the development of bradyarrhythmias, although its mechanism is still unclear. We aim to summarize the existing evidence regarding bradyarrhythmia in COVID-19 and provide future directions for research.Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including"Bradycardia," "atrioventricular block," and "COVID-19″ from their inception to October 13, 2021. Fortythree articles, including 11 observational studies and 59 cases from case reports and series, were included in the systematic review. Although some observational studies reported increased mortality in those with bradyarrhythmia and COVID-19, the lack of comparative groups and small sample sizes hinder the ability to draw definitive conclusions. Among 59 COVID-19 patients with bradycardia from case reports and series, bradycardia most often occurred in those with severe or critical COVID-19, and complete heart block occurred in the majority of cases despite preserved LVEF (55.9%).Pacemaker insertion was required in 76.3% of the patients, most of which were permanent implants (45.8%). This systematic review summarizes the current evidence and characteristics of bradyarrhythmia in patients with COVID-19. Further studies are critical to assess the reversibility of bradyarrhythmia in COVID-19 patients and to clarify potential therapeutic targets including the need for permanent pacing.

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Suspected Hydroxychloroquine-Induced Sinus Bradycardia and QTc Prolongation in a Patient with COVID-19

Cited by 10 publications

References 6 publications

Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

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