The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel coronavirus disease 2019

Abstract

Funding AcknowledgementsType of funding sources: None.BackgroundAlthough long-term use of HCQ and AZT has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Purpose: The aim of this study was to assess the effect of HCQ alone and HCQ + AZT on corrected QT (QTc).Methods: A baseline ECG and on-treatment ECGs were retrospectively collected in COVID-19 patients who received HCQ and/or AZT. Also peak QTc intervals of monotherapy and combination therapy was compared. Results: Of the 155 patients included, 102 (65.8%) were using HCQ, 53 (34.2%) were using HCQ + AZT combination. The use of both HCQ alone and HCQ + AZT combined therapy significantly prolonged the QTc and the QTc interval was significantly longer in patients received combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and in 6 (11.3%) patients in the combined therapy group.Conclusion: Patients who received HCQ for COVID-19 were at high risk of QTc prolongation, and concurrent treatment with AZT was associated with greater changes in QTc. Comparison of baseline characteristics aCharacteristicTotal (n = 155)Hydroxychloroquine (n = 102)Hydroxychloroquine /Azithromycin (n = 53)P valueLength of stay at ward, SD9.54 ± 4.289.64 ± 4.319.31 ± 4.250.88Length of stay Intensive care unite,SD7.92 ± 3.767.18 ± 3.188.46 ± 4.150.29Radiographic findings of pneumonia118(76.1%)76(74.5%)42(49.2%)0.32Mechanically ventilation16(10.3%)7(6.9%)9(17.0%)0.049In hospital death19(12.3%)10(9.8%)9(17.0%)0.15ECG findings median(IQR) (ms)Baseline QRS duration91.0(80.0-103.0)92.5(80.75-105.50)90.0(80.0-102.5)0.5Posttreatment QRS peak97.0(86.0-109.0)97.5(88.0-109.25)95.0(85.5-109)0.68ΔQRS4.0(0.0-9.0)2.0(0.0-8.25)5.0(1.0-9.5)0.14Baseline QTc duration407.0(385.0-426.0)408.0(389.25-427.50)404.0(384.0-420.0)0.1Posttreatment QTc peak437.0(414.0-460.0)428.0(412.75-449.25)456.0(422.0-467.5)<0.001ΔQTc27.0(13.0-45.0)18.0(11.0-30.0)46.0(40.5-54.5)<0.001Baseline PR duration145.50(128.7-160.0)147.0(135.0-160.0)144.0(120.0-160.0)0.53Posttreatment PR peak159.0(140.0-170.0)159.0(141.0-168.50)156.0(139.5-171.0)0.97ΔPR7.0(1.0-13.0)5.0(0.0-12.25)10.0(5.0-15.0)0.022QTc peak day5.0(4.0-5.0)5.0(4.0-6.0)4.0(3.0-5.0)0.022Drug withdrawl due to QRS prolongation11(7.1%)5(4.9%)6(11.3%)0.12