medigraphic.com
ISSN 1995-9427 (Print)

2020, Number 1

<< Back Next >>

Invest Medicoquir 2020; 12 (1)

Prevention of QT interval prolongation and ventricular arrhythmias during COVID-19 treatment.

Blanco GMA, Arencibia LS, Abdo CA, Aroche AR, Quevedo BY, Machado MRE, Vázquez CF, Castellanos GA, González GD

Language: Spanish
References: 37
Page:
PDF size: 392.34 Kb.


ABSTRACT

The COVID -19 has received the qualification of being the worst pandemic of this century and in the absence of specific treatment, the international medical community has had to implement several therapeutic options, (drugs such as lopinavir / ritonavir, azithromycin, chloroquine, hydroxychloroquine, interferons among others). Many of these drugs are a known cause of QT interval prolongation and in turn of ventricular arrhythmias. The objective of this article was to compile the available evidence to provide recommendations in order to prevent or mitigate the risk of QT interval prolongation and ventricular arrhythmias secondary to COVID 19 treatment. To do this, an information search was carried out on the website of the World Health Organization, the European and Inter-American Societies of Cardiology, the American College of Cardiology, Infomed, and in databases such as Scielo, PubMed Central, Redalyc, Medline, Medscape in the period from January 2020 to May 2020. After an analysis to include and exclude research papers, a total of 170 relevant articles were found. The main recommendations were to individualize the action protocols using the Tisdale score, perform daily ECG with QT interval measurement and calculate the QTc, maintain control of the electrolytes (primarily potassium, magnesium and calcium) in the normal range, suspend other drugs that prolong QT. This will reduce cardiovascular mortality from ventricular arrhythmias induced by the drugs used to treat COVID-19.


REFERENCES

  1. Chang D, Lin M, Wei L, et al. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA. 2020; 323:1092-1093.

  2. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020; 323:1061-1069.

  3. European Centre for Disease Prevention and Control (ECDC). COVID-19 in numbers. https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html. Accessed: May 13th, 2020.

  4. The European Society for Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID- 19-Guidance. (Last update: 21 April 2020).

  5. Giudicessi JR, Noseworthy PA, Friedman PA et al. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clinic Proceedings. 2020.

  6. Wu C-I, Postema PG, Arbelo E, et al. SARS-CoV-2, COVID-19 and inherited arrhythmia syndromes. Heart Rhythm. 2020. DOI: https://doi.org/10.1016/j.hrthm.2020.03.024

  7. Roden DM, Harrington RA, Poppas A et al. Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 2019) Treatment. Heart Rhythm. 2020. DOI: https://doi.org/10.1016/j.hrthm.2020.04.016

  8. Barja LD, Fitz Maurice M, Chávez González E. Hidroxicloroquina y azitromicina: riesgo cardiovascular, prolongación de QTc y muerte ubita en el nuevo escenario de la pandemia por COVID-19. Corsalud.2020;12(1):54-59.

  9. Giudicessi JR, Noseworthy PA, Ackerman MJ. The QT Interval. Circulation. 2019;139(24):2711-2713.

  10. Timothy F. Simpson RJK, Eric C. Stecker. Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment for COVID-19. 2020. https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19.

  11. CredibleMeds.COVID-19 experimental therapies and TdP Risk [Internet]. En Línea 20 Marzo 2020 [citado 20 Mar 20]. Disponible en:https://crediblemeds.org/blog/covid-19-experimental-therapies-and-tdp-risk/

  12. Enrique Asensio RA, William Uribe, Eduardo B. Saad, Luis C. Sáenz. recomendaciones para la medicion del intervalo qt durante el uso de medicamentos para el tratamiento de infeccion por covid-19. 2020. https://t.co/a1ph6jw0DW?amp=1&fireglass_rsn=true. Published 3/30/2020.

  13. Hancox JC, Hasnain M, Vieweg WV, Crouse EL, Baranchuk A. Azithromycin, cardiovascular risks, QTc interval prolongation, torsade de pointes, and regulatory issues: A narrative review based on the study of case reports. Therapeutic advances in infectious disease. 2013;1(5):155-165.

  14. Neira V, Enriquez A, Simpson C, Baranchuk A. Update on long QT syndrome. Journal of cardiovascular electrophysiology. 2019;30(12):3068-3078.

  15. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, Shi Z, Hu Z, Zhong W, Xiao G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research 2020;30(3):269-271. https://doi.org/10.1038/s41422-020-0282-0

  16. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, Liu X, Zhao L, Dong E, Song C, Zhan S, Lu R, Li H, Tan W, Liu D. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clinical Infectious Diseases 2020. https://doi.org/10.1093/cid/ciaa237

  17. Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Dupont HT, Honoré S, Colson P, Chabrière E, La Scola B, Rolain J-M, Brouqui P, Raoult D. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents 2020:105949. https://doi.org/https://doi.org/10.1016/j.ijantimicag.2020.105949 Last updated on 21 April 2020. © The European Society of Cardiology 2020. All rights reservedPage | 114

  18. Colson P, Rolain J-M, Lagier J-C, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. International Journal of Antimicrobial Agents 2020:105932. https://doi.org/10.1016/j.ijantimicag.2020.105932

  19. Andrea Cortegiani, Giulia Ingoglia, Mariachiara Ippolito, Antonino Giarratano, Sharon Einav A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19, Journal of Critical Care (2019)Reference:https://doi.org/10.1016/j.jcrc.2020.03.005..

  20. Waleed Alhazzan, Morten Hylander Møller .Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).

  21. Loipa Galán Martínez, Alberto Daniel Calderín Pulido, AliciaFleites Vázquez Acción inotrópico negativa y prolongación del intervalo QT por azitromicina Rev. Cubana deCardiología y CCV. Volumen 23, No 4 (2017).

  22. Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14:72-3.

  23. Haeusler IL, Chan XHS, Guérin PJ, White NJ. The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review. BMC Medicine 2018;16(1):200. https://doi.org/10.1186/s12916-018-1188-2

  24. Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, et al. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ ArrhythmElectrophysiol. 2017; 10: e003560

  25. Zhang M, Xie M, Li S, Gao Y, Xue S, Huang H, et al. Electrophysiologic Studies on the Risks and Potential Mechanism Underlying the Proarrhythmic Nature of Azithromycin. Cardiovasc Toxicol 2017; DOI 10.1007/s12012-017- 9401-7.

  26. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19 [e-pub ahead of print]. N Engl J Med, https://doi.org/10.1056/nejmoa2001282.

  27. Crotti, Lia et al COVID-19, QT Interval an arrhythmic risk: the need foraninternational Registry on Arrhythmias. Heart Rhythm.2020.

  28. Mercuro NJ,Yen CF, Shim DJ et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020; (published online May 1.)DOI:10.1001/jamacardio.2020.1834

  29. Jain S, Workman V, Ganeshan R, et al. Enhanced ECG monitoring of COVID-19 patients. Heart Rhythm 2020, present issue, DOI: https://doi.org/10.1016/j.hrthm.2020.04.047

  30. Chorin E, Dai M, Shulman E, et al. The QT Interval in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine/Azithromycin. medRxiv. 2020:2020.04.02.20047050.

  31. Saleh M, Gabriels J, Chang D, et al. The Effect of Chloroquine, Hydroxychloroquine and Azithromycin onthe Corrected QT Interval in Patients with SARS-CoV-2 Infection. Circulation: Arrhythmia and Electrophysiology. 2020;0.

  32. Geleris J, Sun Y, Platt J, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. New England Journal of Medicine. 2020.

  33. Borba MGS, Val FFA, Sampaio VS, et al. Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-Infection: A Randomized Clinical Trial. JAMA Network Open. 2020;3: e208857-e208857.

  34. Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine. 2020; 382:1787-1799.

  35. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. 2020.

  36. Mehra, Mandeep R et al. Hydroxicloroquine whith or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. 2020.

  37. Tisdale JE, Jayes HA, Kingery JR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013; 6:479-487.




2020     |     www.medigraphic.com