Enhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019

Abstract

BACKGROUND Many of the drugs being used in the treatment of the ongoing pandemic coronavirus disease 2019 (COVID-19) are associated with QT prolongation. Expert guidance supports electrocardiographic (ECG) monitoring to optimize patient safety.OBJECTIVE The purpose of this study was to establish an enhanced process for ECG monitoring of patients being treated for COVID-19.METHODS We created a Situation Background Assessment Recommendation tool identifying the indication for ECGs in patients with COVID-19 and tagged these ECGs to ensure prompt over reading and identification of those with QT prolongation (corrected QT interval . 470 ms for QRS duration 120 ms; corrected QT interval . 500 ms for QRS duration . 120 ms). This triggered a phone call from the electrophysiology service to the primary team to provide management guidance and a formal consultation if requested.RESULTS During a 2-week period, we reviewed 2006 ECGs, corresponding to 524 unique patients, of whom 103 (19.7%) met the Situation Background Assessment Recommendation tool-defined criteria for QT prolongation. Compared with those without QT prolongation, these patients were more often in the intensive care unit (60 [58.3%] vs 149 [35.4%]) and more likely to be intubated (32 [31.1%] vs 76 [18.1%]). Fifty patients with QT prolongation (48.5%) had electrolyte abnormalities, 98 (95.1%) were on COVID-19-related QT-prolonging medications, and 62 (60.2%) were on 1-4 additional non-COVID-19-related QT-prolonging drugs. Electrophysiology recommendations were given to limit modifiable risk factors. No patient developed torsades de pointes.CONCLUSION This process functioned efficiently, identified a high percentage of patients with QT prolongation, and led to relevant interventions. Arrhythmias were rare. No patient developed torsades de pointes.

New-Onset Cardiac Arrhythmias During COVID-19 Hospitalization

“…The use of hydroxychloroquine (or chloroquine), azithromycin, and antiviral drugs could cause prolongation of the QT interval with an increased risk of arrhythmias. We observed cQT prolongation in 5 patients (17%), similar to a previous study, 5 but no sustained ventricular tachycardias were observed.…”

Absence of relevant QT interval prolongation in not critically ill COVID-19 patients

“…Previous studies with extremely prolonged basal QT intervals may not reflect the patient’s real-world baseline repolarization status. These data have been replicated recently by the group from Yale 16 , that describe a significantly prolonged QTc interval after treatment among patients admitted to ICU after reviewing more than two thousands ECGs of patients with COVID-19; on the other hand, previous studies focus mostly on American population 12 – 15 , with lack of large series in other regions. A single European work showed a significantly prolonged QT interval in more than 20% of the sample 17 , but in this case patients were treated with chloroquine, which is known to affect QT interval in a greater degree than HCQ.…”

Electrocardiograhic characteristics in patients with coronavirus infection: A single‐center observational study

“…(103/524) of patients with COVID-19 had prolonged QTc interval and were more likely to be admitted to the ICU (Jain et al, 2020). Drugs for treating COVID-19 were regarded as the main cause of QTc prolongation, and this effect may be amplified when multiple QT-prolonging drugs were used in combination.…”

“…Although QTc prolongation was more common in the ICU group (34.8% vs. 8.9%), there was no significant difference in values between the two groups in our cohort ( p = .184). Jain S et al reported that 19.7% (103/524) of patients with COVID‐19 had prolonged QTc interval and were more likely to be admitted to the ICU (Jain et al, 2020). Drugs for treating COVID‐19 were regarded as the main cause of QTc prolongation, and this effect may be amplified when multiple QT‐prolonging drugs were used in combination.…”