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Effects of hydroxychloroquine and azithromycin use on ECG parameters due to COVID-19 in pediatric patient population

Varan et al., Adıyaman Üniversitesi Sağlık Bilimleri Dergisi, doi:10.30569/adiyamansaglik.1313270
Oct 2023  
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Safety analysis with 23 pediatric COVID-19 patients examining the effects of hydroxychloroquine (HCQ), with or without azithromycin (AZ), on electrocardiogram (ECG) parameters. Most patients were mildly symptomatic or asymptomatic. Baseline and post-treatment ECG measurements of QT, QTc, Tpe, Tpe/QT, and Tpe/QTc intervals showed no significant arrhythmogenic effects. The authors conclude that HCQ and AZ did not prolong QT/QTc intervals or demonstrate proarrhythmic effects in this pediatric population with mild or no COVID-19 symptoms.
Varan et al., 17 Oct 2023, retrospective, Turkey, peer-reviewed, mean age 13.3, 3 authors, study period 28 March, 2020 - 25 May, 2020. Contact: celalvaran@hotmail.com.
This PaperHCQAll
Effects of hydroxychloroquine and azithromycin use on ECG parameters due to COVID-19 in pediatric patient population Pediatrik hasta popülasyonunda COVİD-19 sebebiyle hidroksiklorokin ve azitromisin kullanımın EKG
Bu Eser, Creative Commons, Uluslararası Telif Lisansı, Hakkı, Hatice Uygun, Mehmet Turgut, Celal Varan
Aim: Due to COVID-19 infection, the use of two drugs, hydroxychloroquine and azithromycin, with a high potential for arrhythmia, came to the fore in the pediatric patient group at the beginning of 2020, during the search for treatment. The aim is to reveal the synergistic arrhythmic effects of these two drugs in prolonging the QT interval on the ECG. Materials and Methods: First of all, patients taking hydroxychloroquine were identified. Demographic data of these patients were recorded. In addition to hydroxychloroquine, azithromycin and other treatments they used were also recorded. Those with ECG data were selected. Transmyocardial repolarization parameters calculated by ECG were calculated retrospectively (QT, QTc, Tpe, Tpe/QT, Tpe/QTc). Then, laboratory findings and radiological imaging of these patients were recorded. Results: Twenty-three pediatric patients who met the study criteria were identified. All of the patients were asymptomatic or mild disease. When initial and postdrug ECG parameters were compared; It was observed that the drugs did not have a significant arrhythmogenic effect on ECG parameters, especially QT interval and QTc. Conclusion: Unlike the literature showing arrhythmic effects of these drugs in adult COVID-19 disease, hydroxychloroquine and azithromycin did not show such an effect in the pediatric population.
Ethics Committee Approval Ethics committee approval was obtained with the decision of the Ethics Committee for Non-Interventional Procedures of Adıyaman University, dated and numbered 2020: 8/11. The study was conducted under the principles of the Declaration of Helsinki. Informed Consent Data concerning the study were collected with the permission of the Adıyaman Provincial Health Directorate. Authors Contrubituons All of the authors contributed at every stage of the study Conflict of Interests There is no conflict of interest to declare. Financial Disclosure No person/organization is supporting this study financially. Statements These research results have yet to be presented anywhere previously. Data related to the study is available on request. Peer-review Externally peer-reviewed.
References
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Arfaras-Melainis, Tzoumas, Kokkinidis, Effect of hydroxychloroquine on qtc in patients diagnosed with covid-19: A systematic review and meta-analysis, J Cardiovasc Dev Dis, doi:10.3390/jcdd8050055
Asensio, Acunzo, Uribe, Saad, Sáenz, Recommendations for the measurement of the QT interval during the use of drugs for COVID-19 infection treatment. Updatable in accordance with the availability of new evidence, J Interv Card Electrophysiol, doi:10.1007/s10840-020-00765-3
Avcu, Arslan, Bal, Electrocardiographic changes in hospitalised children with COVID-19, Cardiol Young, doi:10.1017/S1047951123000100
Chorin, Dai, Shulman, The QT interval in patients with SARS-CoV-2 infection treated with hydroxychloroquine/azithromycin, Nature medicine, doi:10.1101/2020.04.02.20047050
Ece, Koçoğlu, Kavurt, Assessment of Cardiac Arrhythmic Risk in Children With Covid-19 Infection, Pediatr Cardiol, doi:10.1007/s00246-020-02474-0
Haeusler, Chan, Guérin, White, The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review, BMC Med
Hormigo, Silva, Laranjo, Protocol-based cardiotoxicity monitoring in hydroxychloroquine medicated COVID-19 pediatric patients, Revista Portuguesa de Cardiologia
Jankelson, Karam, Becker, Chinitz, Tsai, QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review, Heart Rhythm, doi:10.1016/j.hrthm.2020.05.008
Lane, Weaver, Kostka, Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study
Mzayek, Deng, Mather, Randomized dose-ranging controlled trial of AQ-13, a candidate antimalarial, and chloroquine in healthy volunteers, PLoS Clin Trials
Nishiga, Wang, Han, Lewis, Wu, COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives, Nat Rev Cardiol, doi:10.1038/s41569-020-0413-9
Parthasarathy, Shaikh, Ryan, Mondal, Does treatment with hydroxychloroquine or chloroquine lead to QTc prolongation in children?, Prog Pediatr Cardiol, doi:10.1016/j.ppedcard.2021.101465
Pastick, Okafor, Wang, Hydroxychloroquine and chloroquine for treatment of SARS-CoV-2 (COVID-19), Open Forum Infect Dis, doi:10.1093/ofid/ofaa130
Roden, Predicting drug-induced QT prolongation and torsades de pointes, J Physiol, doi:10.1113/JP270526
Samuel, Friedman, Sharma, Incidence of arrhythmias and electrocardiographic abnormalities in symptomatic pediatric patients with PCR-positive SARS-CoV-2 infection, including drug-induced changes in the corrected QT interval, Heart Rhythm, doi:10.1016/j.hrthm.2020.06.033
Sağlık, Bakanlığı, COVID-19 (SARS-CoV-2 Enfeksiyonu) Çocuk Hasta Yönetimi ve Tedavi Rehberi
Soysal, Gönüllü, Arslan, Comparison of clinical and laboratory features and treatment options of 237 symptomatic and asymptomatic children infected with SARS-CoV-2 in the early phase of the COVID-19 pandemic in Turkey, Japanese Journal of Infectious Diseases
Tuncer, Karaci, Boga, Durmaz, Guven, QT Interval Evaluation Associated with Use of Hydroxychloroquine with Combined Use of Azithromycin among Hospitalized Children Positive for COVID-19, Cardiol Young, doi:10.1017/S1047951120002425
Wu, Postema, Arbelo, SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes, Heart Rhythm, doi:10.1016/j.hrthm.2020.03.024
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(Accessed date: 30.05. 2021).'}, { 'key': 'ref8', 'doi-asserted-by': 'crossref', 'unstructured': 'Soysal A, Gönüllü E, Arslan H, et al. Comparison of clinical and ' 'laboratory features and treatment options of 237 symptomatic and ' 'asymptomatic children infected with SARS-CoV-2 in the early phase of the ' 'COVID-19 pandemic in Turkey. Japanese Journal of Infectious Diseases. ' '2021; 74(4): 273-279.', 'DOI': '10.7883/yoken.JJID.2020.781'}, { 'key': 'ref9', 'doi-asserted-by': 'crossref', 'unstructured': 'Ece İ, Koçoğlu M, Kavurt AV, et al. Assessment of Cardiac Arrhythmic ' 'Risk in Children With Covid-19 Infection. Pediatr Cardiol. ' '2020;42(2):264-268. doi:10.1007/s00246-020-02474-0.', 'DOI': '10.1007/s00246-020-02474-0'}, { 'key': 'ref10', 'doi-asserted-by': 'crossref', 'unstructured': 'Jankelson L, Karam G, Becker ML, Chinitz LA, Tsai MC. 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