Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings

DOI record: { "DOI": "10.1093/europace/euaa216", "ISSN": [ "1099-5129", "1532-2092" ], "URL": "http://dx.doi.org/10.1093/europace/euaa216", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Aims</jats:title>\n <jats:p>The aim of the study was to describe ECG modifications and arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in different clinical settings.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods and results</jats:title>\n <jats:p>COVID-19 patients at seven institutions receiving HCQ therapy from whom a baseline and at least one ECG at 48+ h were available were enrolled in the study. QT/QTc prolongation, QT-associated and QT-independent arrhythmic events, arrhythmic mortality, and overall mortality during HCQ therapy were assessed. A total of 649 COVID-19 patients (61.9 ± 18.7 years, 46.1% males) were enrolled. HCQ therapy was administrated as a home therapy regimen in 126 (19.4%) patients, and as an in-hospital-treatment to 495 (76.3%) hospitalized and 28 (4.3%) intensive care unit (ICU) patients. At 36–72 and at 96+ h after the first HCQ dose, 358 and 404 ECGs were obtained, respectively. A significant QT/QTc interval prolongation was observed (P &amp;lt; 0.001), but the magnitude of the increase was modest [+13 (9–16) ms]. Baseline QT/QTc length and presence of fever (P = 0.001) at admission represented the most important determinants of QT/QTc prolongation. No arrhythmic-related deaths were reported. The overall major ventricular arrhythmia rate was low (1.1%), with all events found not to be related to QT or HCQ therapy at a centralized event evaluation. No differences in QT/QTc prolongation and QT-related arrhythmias were observed across different clinical settings, with non-QT-related arrhythmias being more common in the intensive care setting.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusion</jats:title>\n <jats:p>HCQ administration is safe for a short-term treatment for patients with COVID-19 infection regardless of the clinical setting of delivery, causing only modest QTc prolongation and no directly attributable arrhythmic deaths.</jats:p>\n </jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0003-3432-070X", "affiliation": [ { "name": "Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy" }, { "name": "University Heart Center, University Hospital Zürich, Zürich, Switzerland" } ], "authenticated-orcid": false, "family": "Gasperetti", "given": "Alessio", "sequence": "first" }, { "affiliation": [ { "name": "Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy" } ], "family": "Biffi", "given": "Mauro", "sequence": "additional" }, { "affiliation": [ { "name": "University Heart Center, University Hospital Zürich, Zürich, Switzerland" } ], "family": "Duru", "given": "Firat", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy" } ], "family": "Schiavone", "given": "Marco", "sequence": "additional" }, { "affiliation": [ { "name": "Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy" } ], "family": "Ziacchi", "given": "Matteo", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy" } ], "family": "Mitacchione", "given": "Gianfranco", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy" } ], "family": "Lavalle", "given": "Carlo", "sequence": "additional" }, { "affiliation": [ { "name": "University Heart Center, University Hospital Zürich, Zürich, Switzerland" } ], "family": "Saguner", "given": "Ardan", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy" } ], "family": "Lanfranchi", "given": "Antonio", "sequence": "additional" }, { "affiliation": [ { "name": "III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy" } ], "family": "Casalini", "given": "Giacomo", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy" } ], "family": "Tocci", "given": "Marco", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Cardiology, Spedali Civili Hospital, Brescia, Italy" } ], "family": "Fabbricatore", "given": "Davide", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Cardiology, Spedali Civili Hospital, Brescia, Italy" } ], "family": "Salghetti", "given": "Francesca", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy" } ], "family": "Mariani", "given": "Marco Valerio", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany" } ], "family": "Busana", "given": "Mattia", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Systems Medicine, University of Rome ‘Tor Vergata’, Rome, Italy" } ], "family": "Bellia", "given": "Alfonso", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, Luigi Sacco Hospital, University of Milan, Milan, Italy" } ], "family": "Cogliati", "given": "Chiara Beatrice", "sequence": "additional" }, { "affiliation": [ { "name": "Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy" }, { "name": "Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy" } ], "family": "Viale", "given": "Pierluigi", "sequence": "additional" }, { "affiliation": [ { "name": "III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy" } ], "family": "Antinori", "given": "Spinello", "sequence": "additional" }, { "affiliation": [ { "name": "III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy" } ], "family": "Galli", "given": "Massimo", "sequence": "additional" }, { "affiliation": [ { "name": "Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy" } ], "family": "Galiè", "given": "Nazzareno", "sequence": "additional" }, { "affiliation": [ { "name": "Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy" }, { "name": "Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy" } ], "family": "Tondo", "given": "Claudio", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy" } ], "family": "Forleo", "given": "Giovanni Battista", "sequence": "additional" } ], "container-title": "EP Europace", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2020, 7, 3 ] ], "date-time": "2020-07-03T19:27:29Z", "timestamp": 1593804449000 }, "deposited": { "date-parts": [ [ 2020, 12, 24 ] ], "date-time": "2020-12-24T05:38:31Z", "timestamp": 1608788311000 }, "indexed": { "date-parts": [ [ 2024, 2, 23 ] ], "date-time": "2024-02-23T19:08:24Z", "timestamp": 1708715304147 }, "is-referenced-by-count": 25, "issue": "12", "issued": { "date-parts": [ [ 2020, 9, 24 ] ] }, "journal-issue": { "issue": "12", "published-online": { "date-parts": [ [ 2020, 9, 24 ] ] }, 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