Mitigating Arrhythmia Risk in Hydroxychloroquine and Azithromycin Treated COVID-19 Patients using Arrhythmia Risk Management Plan

Abstract

Background: Hydroxychloroquine and Azithromycin use is associated with QT interval prolongation and arrhythmias. Despite ongoing multiple clinical trials for treatment of COVID19 infection, no definite cardiac safety protocols were proposed. The aim of our study was to assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using close monitoring and arrhythmia risk management plan.Methods and results: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined cardiac arrhythmia risk management plan. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. 7 patients (8.6%) had QTc prolongation of ≥500 ms. The treatment was discontinued in 4 patients (4.9%). 14 patients (17.3%) experienced QTc≥480 ms and 16 patients (19.8%) had an increase of QTc≥60 ms. None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc≥500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients had a lethal outcome; none of them associated with ventricular arrhythmias.Conclusion: We recorded a low incidence of QTc prolongation ≥500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan.

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities

“…Clinical implications of the QT-prolongation, however, have conflicting data. Several studies have shown no significant difference in arrhythmogenic events and overall outcomes 92 , 93 , 94 . QTc prolongation tended to occur more often in COVID patients who had worsening renal disease and myocardial injury 95 .…”

Impact of COVID-19 infection on the cardiovascular system: An evidence-based analysis of risk factors and outcomes

“…There is a risk of QT interval prolongation and arrhythmia associated with the experimental use of chloroquine/hydroxychloroquine for the treatment of COVID-19 infection, or prophylaxis. However, Maneikis, et al concluded that it would be possible to mitigate the risk of arrhythmia by utilizing an arrhythmia risk management plan ( 51 ).…”

SARS-CoV-2 and Cystic Fibrosis: Expectations Versus Reality, a Literature Review

“…32,49 A study retrospectively reviewed 81 patients treated with hydroxychloroquine and azithromycin and found that 7/81 (8.6%) had QTc prolongation (≥500 ms), with no patients developing ventricular tachycardia. 50 Therefore, the AIFA, EMA, U.S. Food and Drug Administration (FDA), and WHO do not recommend azithromycin or macrolide antibiotics for the treatment of COVID-19 without an underlying bacterial infection. 32…”