The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection
Saleh et al.
, The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with..
, Circulation: Arrhythmia and Electrophysiology, doi:10.1161/CIRCEP.120.008662
201 hospitalized patients. No serious side effects of HCQ. No instances of Torsade de pointes, or arrhythmogenic death were reported. They report that although use of these medications resulted in QT prolongation, clinicians seldom need to discontinue therapy.
Saleh et al., 29 Apr 2020, peer-reviewed, 17 authors.
Abstract: The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the
Corrected QT Interval in Patients with SARS-CoV-2 Infection
Running title: Saleh et al.; COVID-19 therapy effect on the QTc
Moussa Saleh, MD1,4; James Gabriels, MD1; David Chang, MD1; Beom Soo Kim, MD1;
Amtul Mansoor, MD1; Eitezaz Mahmood, MD1; Parth Makker, MD1,4; Haisam Ismail, MD2;
Bruce Goldner, MD2; Jonathan Willner, MD1; Stuart Beldner, MD1; Raman Mitra, MD, PHD1;
Roy John, MBBS, PHD1; Jason Chinitz, MD3; Nicholas Skipitaris, MD4;
Stavros Mountantonakis, MD4; Laurence M. Epstein, MD1
Northwell Health, North Shore University Hospital, Department of Cardiology, Division of
Electrophysiology, Manhasset; 2Northwell Health, Long Island Jewish Medical Center,
Department of Cardiology, Division of Electrophysiology, New Hyde Park; 3Northwell Health,
Southside Hospital, Department of Cardiology, Division of Electrophysiology, Bay Shore;
Northwell Health, Lenox Hill Hospital, Department of Cardiology, Division of
Electrophysiology, New York, NY
Moussa Saleh, MD
Northwell Health, North Shore University Hospital
Department of Cardiology, Division of Electrophysiology
300 Community Drive
Manhasset, NY 11030
Tel: (516) 562-4100
Fax: (516) 562-2015
Journal Subject Terms: Arrhythmias; Sudden Cardiac Death; Treatment; Electrophysiology
Background - The novel SARs-CoV-2 coronavirus is responsible for the global COVID-19
pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine ±
azithromycin for the treatment of COVID-19. Use of these medications alone, or in
combination, can lead to a prolongation of the QT interval, possibly increasing the risk of
Torsade de pointes (TdP) and sudden cardiac death.
Methods - Hospitalized patients treated with chloroquine/hydroxychloroquine ± azithromycin
from March 1st through the 23rd at three hospitals within the Northwell Health system were
included in this prospective, observational study. Serial assessments of the QT interval were
performed. The primary outcome was QT prolongation resulting in TdP. Secondary outcomes
included QT prolongation, the need to prematurely discontinue any of the medications due to QT
prolongation and arrhythmogenic death.
Results - Two hundred one patients were treated for COVID-19 with
chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%)
received hydroxychloroquine and 119 (59.2%) also received azithromycin. The primary outcome
of TdP was not observed in the entire population. Baseline QTc intervals did not differ between
patients treated with chloroquine/hydroxychloroquine (monotherapy group) vs. those treated
with combination group (chloroquine/hydroxychloroquine and azithromycin) (440.6 ± 24.9 ms
vs. 439.9 ± 24.7 ms, p =0.834). The maximum QTc during treatment was significantly longer in
the combination group vs the monotherapy group (470.4 ± 45.0 ms vs. 453.3 ± 37.0 ms, p =
0.004). Seven patients (3.5%) required discontinuation of these medications due to QTc
prolongation. No arrhythmogenic deaths were reported.
Conclusions - In the largest reported cohort of COVID-19 patients to date treated with
chloroquine/hydroxychloroquine ± azithromycin, no instances of TdP or arrhythmogenic death
were reported. Although use of these medications resulted in QT prolongation,..
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