Key result
Hydroxychloroquine and azithromycin combination therapy significantly increased the Tp-e interval from a median of 75 ms to 79 ms (p<0.001) in COVID-19 patients, despite no significant QTc prolongation.
Why the study?
Hydroxychloroquine and azithromycin combination therapy for COVID-19 increases the risk of QTc prolongation and cardiac arrhythmias, requiring characterization of ventricular repolarization indexes associated with malignant ventricular arrhythmias.
Does hydroxychloroquine and azithromycin combination therapy increase ventricular repolarization indexes in patients with COVID-19?
Observational (n=81)
No
Does hydroxychloroquine and azithromycin combination therapy increase ventricular repolarization indexes in patients with COVID-19?
Absolute Event Rate: 79% vs 75%
p-value: p=<0.001
In COVID-19 patients treated with hydroxychloroquine and azithromycin, ventricular repolarization indexes significantly increased even without QTc prolongation, suggesting QTc monitoring alone may be insufficient for arrhythmia risk assessment.
QTc monitoring alone may miss repolarization risk with this therapy; leaves open prospective validation of Tp-e in COVID-19.
BACKGROUND: Combination of hydroxychloroquine and azithromycin for the treatment of coronavirus disease 2019 (COVID-19) carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias. OBJECTIVE: To characterize the ventricular repolarization indexes which are associated with malignant ventricular arrhythmias in patients treated with hydroxychloroquine and concomitant azithromycin for COVID-19. METHOD: A total of 81 patients who had hydroxychloroquine and azithromycin combination therapy because of possible or reverse-transcription polymertase chain reaction (RT-PCR) confirmed diagnosis of COVID-19 were included in the study. Baseline and control electrocardiograms (before and after treatment) were analyzed retrospectively. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios, which are ventricular repolarization indexes, were calculated. RESULTS: While there was no significant increase in QTc interval in patients receiving combination therapy, there was a significant increase in ventricular repolarization indexes. CONCLUSION: The increase in ventricular replarization indexes is associated with the risk of arrhythmia. In patients using QTc prolonging medication for COVID-19 treatment, QTc monitoring alone may not be sufficient to follow-up for arrhythmia. Even if there is no prolongation in QTc, an increase in ventricular repolarization indexes may be seen (Tab. 5, Ref. 37).
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Günay et al. (2020) conducted an observational in COVID-19 (n=81). Hydroxychloroquine and azithromycin vs. Pre-treatment baseline was evaluated on Tp-e interval (ms) (p=<0.001). Hydroxychloroquine and azithromycin combination therapy significantly increased the Tp-e interval from a median of 75 ms to 79 ms (p<0.001) in COVID-19 patients, despite no significant QTc prolongation.
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