Heart Failure, Kidney Function, and Elderly Age, Rather than Levofloxacin Therapy, Are Associated with QTc Prolongation in COVID-19 Patients

Background: Prolongation of the QT interval is directly related to the risk of ventricular arrhythmias and sudden cardiac death. Age, comorbidities, and treatment schemes have been shown to influence its prolongation and may also significantly affect the course of SARS-CoV-2 infection. Fluoroquinolones, widely used during the COVID-19 pandemic, are known for their ability to prolong the QT interval. Risk of ventricular arrhythmias has also been reported in patients with infectious diseases, and this risk may have been associated with high levels of interleukin-6 (IL-6). Purpose: The aim of this study is to evaluate the effect of levofloxacin on the corrected QT interval in patients with COVID-19, as well as to identify sociodemographic, clinical, and biochemical parameters associated with QTc interval prolongation among patients with COVID-19. Patients and Methods: The medical records of 93 patients hospitalized for COVID-19 were retrospectively analyzed, focusing on the presence of comorbidities and treatment with levofloxacin. Selected sociodemographic, clinical, and biochemical parameters were then statistically analyzed, with emphasis on their effect on the corrected QTc interval. The QTc interval was calculated according to the Bazett formula. Results: Levofloxacin use was not significantly associated with QTc interval. Statistical analysis identified creatinine, heart failure and atrial fibrillation as significant predictors of QTc interval prolongation. The trends towards QTc interval prolongation observed with hypokalaemia and hypertension suggest that these factors may also contribute to QTc interval variability and should be taken into account when assessing arrhythmia risk. Conclusions: Our retrospective study indicates that QTc prolongation results from the interplay of multiple factors.