QT interval and arrhythmic safety of hydroxychloroquine monotherapy in coronavirus disease 2019
Arun R Sridhar1, Neal A Chatterjee1, Basil Saour1
1Division of Cardiology, University of Washington, Seattle, Washington.
Insights
Hydroxychloroquine (HCQ) monotherapy in COVID-19 patients did not lead to sustained ventricular arrhythmias. A small percentage experienced QTc prolongation, indicating a need for careful monitoring during HCQ treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Previous studies linked hydroxychloroquine (HCQ) and azithromycin combination to increased cardiovascular risk in COVID-19 patients.
- The safety of HCQ monotherapy for COVID-19 treatment and prophylaxis requires further investigation.
Purpose of the Study:
- To evaluate the arrhythmic safety profile of hydroxychloroquine (HCQ) monotherapy in hospitalized COVID-19 patients.
- To assess the incidence of sustained ventricular arrhythmia, arrhythmic cardiac arrest, and QTc prolongation.
Main Methods:
- A cohort of 111 COVID-19 patients treated with HCQ monotherapy was identified.
- Patients underwent systematic surveillance for arrhythmias and QT interval changes using serial electrocardiograms (ECGs).
- Primary endpoint: in-hospital sustained ventricular arrhythmia or arrhythmic cardiac arrest; Secondary endpoint: clinically significant QTc prolongation.
Main Results:
- No sustained ventricular arrhythmias or arrhythmic cardiac arrests occurred in patients receiving HCQ monotherapy.
- Clinically significant QTc prolongation was observed in 7% of patients with serial ECGs.
- No significant QTc interval changes were noted in subgroups with cardiovascular disease or on renin-angiotensin-aldosterone axis inhibitors.
Conclusions:
- HCQ monotherapy, under systematic monitoring, was not associated with malignant ventricular arrhythmias in hospitalized COVID-19 patients.
- A minority of patients exhibited clinically significant QTc prolongation, highlighting the importance of monitoring during HCQ therapy.
Background:
Observational studies have suggested increased arrhythmic and cardiovascular risk with the combination use of hydroxychloroquine (HCQ) and azithromycin in patients with coronavirus disease 2019 (COVID-19).
Objective:
The arrhythmic safety profile of HCQ monotherapy, which remains under investigation as a therapeutic and prophylactic agent in COVID-19, is less established and we sought to evaluate this.
Methods:
In 245 consecutive patients with COVID-19 admitted to the University of Washington hospital system between March 9, 2020, and May 10, 2020, we identified 111 treated with HCQ monotherapy. Patients treated with HCQ underwent a systematic arrhythmia and QT interval surveillance protocol including serial electrocardiograms (ECG) (baseline, following second HCQ dose). The primary endpoint was in-hospital sustained ventricular arrhythmia or arrhythmic cardiac arrest. Secondary endpoints included clinically significant QTc prolongation.
Results:
A total of 111 patients with COVID-19 underwent treatment with HCQ monotherapy (mean age 62 ± 16 years, 44 women [39%], serum creatinine 0.9 [interquartile range 0.4] mg/dL). There were no instances of sustained ventricular arrythmia or arrhythmic cardiac arrest. In 75 patients with serial ECGs, clinically significant corrected QT (QTc) prolongation was observed in a minority (n = 5 [7%]). In patients with serial ECGs, there was no significant change in the QTc interval in prespecified subgroups of interest, including those with prevalent cardiovascular disease or baseline use of renin-angiotensin-aldosterone axis inhibitors.
Conclusions:
In the context of a systematic monitoring protocol, HCQ monotherapy in hospitalized COVID-19 patients was not associated with malignant ventricular arrhythmia. A minority of patients demonstrated clinically significant QTc prolongation during HCQ therapy.
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