Torsades de pointes associated with remdesivir treatment for COVID-19 pneumonia

Prolonged QT interval (QTc) can be a serious adverse event from SARS-CoV-2 infection and associated treatment, including remdesivir.

We present a case of a 55-year-old woman with COVID-19 pneumonia who was treated with remdesivir. The QTc on admission was 483 ms. After three doses of remdesivir, she had an episode of non-sustained ventricular tachycardia. Repeat QTc was significantly prolonged at 609 ms. She experienced a polymorphic ventricular tachycardic cardiac arrest the next morning, thought to be secondary to torsades de pointes.

Transthoracic echocardiogram showed normal biventricular function. Electrolytes were within normal limits. In the absence of other QTc-prolonging medications, remdesivir was thought to be inciting agent. Following discontinuation of remdesivir, the patient's QTc returned to baseline.

There is a risk for cardiac events from QTc prolongation effects of SARS-CoV-2 infection and associated treatment. We recommend pharmacological profile review and cardiac monitoring for patients receiving remdesivir.