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Does artesunate prolong the electrocardiograph QT interval in patients with severe malaria?

Richard J Maude1, Katherine Plewes, M Abul Faiz

  • 1Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. richard@tropmedres.ac

The American Journal of Tropical Medicine and Hygiene
|January 15, 2009
PubMed

Insights

Intravenous artesunate, an artemisinin derivative, did not significantly prolong the corrected QT (QTc) interval in patients with severe falciparum malaria. This suggests artesunate is safe for cardiac function in this vulnerable population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Antimalarial drugs can prolong the electrocardiograph QT interval, increasing the risk of fatal arrhythmias.
  • Artemisinin derivatives, like artesunate, are crucial for malaria treatment, but potential cardiac effects require investigation.
  • Previous studies in dogs suggested a possible class effect of QT prolongation with artemisinin derivatives.

Observation:

  • Serial electrocardiograms were performed on 21 adult patients with severe falciparum malaria before and after intravenous artesunate administration.
  • Cardiac intervals (QTc, JTc, PR), QRS width, blood pressure, and heart rate were monitored.
  • Mortality rate in the study cohort was 38% (8 out of 21 patients).

Findings:

  • Intravenous artesunate (2.4 mg/kg bolus) did not significantly alter the mean QTc interval in patients.
  • Two patients experienced QTc intervals exceeding 0.5 seconds, but alternative explanations were plausible.
  • No significant effects were observed on JTc, PR interval, QRS width, blood pressure, or heart rate.

Implications:

  • Intravenous artesunate appears to have a favorable cardiovascular safety profile in severe falciparum malaria patients.
  • The findings alleviate concerns about a potential class effect of QT prolongation with artesunate.
  • Artesunate can be safely administered to critically ill malaria patients without significant cardiac risk.

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