The QT Interval in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine/Azithromycin

Abstract

We report the change in the QT interval in 84 adult patients with SARS-CoV-2 infection treated with Hydroxychloroquine/Azithromycin combination. QTc prolonged maximally from baseline between days 3 and 4. in 30% of patients QTc increased by greater than 40ms. In 11% of patients QTc increased to >500 ms, representing high risk group for arrhythmia. The development of acute renal failure but not baseline QTc was a strong predictor of extreme QTc prolongation.

Review of Current Evidence of Hydroxychloroquine in Pharmacotherapy of COVID-19

“…QT prolongation and arrhythmias can be precipitated by concomitant use of azithromycin. 44 Small but absolute risk of cardiovascular death is seen to be associated significantly with azithromycin as compared to fluoroquinolones. 51 It is important to note that overdose or poisoning of HCQ is difficult to treat.…”

“…The authors noted that in 30% of patients, increase in QTc was greater than 40ms and 11% patients showed QTc increase to greater than 500ms, they commented that development of acute renal failure during the therapy could be a strong predictor of extreme QTc prolongation. 44 (Table 3)…”

Is there a future for hydroxychloroquine/chloroquine in prevention of SARS-CoV-2 infection (COVID-19)?

“…8 Potential side effects of HCQ and CQ, such as retinopathy, vomiting, diarrhoea and prolongation of QT interval with increased risk of arrhythmia, should be also taken into account. 9 Currently, HCQ and CQ are under investigation in several randomised clinical trials for pre-exposure or postexposure prophylaxis of SARS-CoV-2 infection, including COPCOV (UK, n=40 000), ALBERTA HOPE (Canada, n=1660), COVIDAXIS (France, n=600), PATCH (USA, n=400), NCT04333225 (USA, n=360), NCT04318444 (USA, n=1600), NCT04328961 (USA, n=2000), HYCOVID (France, n=1300) and NCT04328467 (USA, n=3500). Is it really necessary to conduct similar largescale trials across the world?…”

Préconisations cardiologiques lors de l’utilisation d’un traitement pouvant entraîner des troubles conductifs ou un allongement de l’intervalle QT dans le COVID-19

“…Neuf patients ont eu une prolongation du QTc supérieure à 60 ms mais aucun évènement cardiaque n'a été noté. Chez 84 patients hospitalisés atteints de COVID-19 dont certains en réanimation [7], l'association hydroxychloroquine/azithromycine a entraîné un allongement du QTc supérieur à 500 ms chez 11 % avec comme facteur prédictif majeur, la survenue d'une insuffisance rénale aiguë. Aucun évènement rythmique péjoratif n'a été rapporté dans ces séries préliminaires.…”