Proarrhythmia assessment in treatment with hydroxychloroquine and azithromycin hospitalized elderly COVID-19 patients - our experience
Open Access
- 18 June 2021
- journal article
- Published by PAGEPress Publications in Geriatric Care
- Vol. 7 (2)
- https://doi.org/10.4081/gc.2021.9536
Abstract
The aim of our study was to characterize the repolarization disorders propensity induced by drug-drug interaction. In this observational retrospective study, we report our experience on all elderly patients with ascertained diagnosis of coronavirus disease 2019 through nasopharyngeal swab with real time-polymerase chain reaction at our Pugliese-Ciaccio hospital in Catanzaro, who received hydroxychloroquine (HCQ), with or without azithromycin (AZY). 33 hospitalized patients were examined. We calculated QT value, cQT, QT dispersion, and cQT dispersion and examined possible progression on the basal electrocardiogram (T0) and after the insertion of the drug (T1). The QT value is increased by T0 vs T1 (370±40.74 vs 420±36.91 ms; P=0.000), as well as the cQT value (408±25.40 vs 451.54±58.81; P=0.003), the QT dispersion (QTd: 36.36±14.53 vs 50.90±13.12 ms; P=0.000); the dispersion of cQTc (cQTd 46.27±18.72 vs 63.18±21.93 ms; P=0.001). The ΔQT was 37.44±44.09 while the ΔcQT was 32.01±56.47). The main determinant of QTc prolongation is the number of drug at risk of prolongation of the QT that could influence the ventricular repolarization phase. The use of HCQ in combination with AZY, in patients suffering from severe acute respiratory syndrome-related coronavirus-2, can favor the onset of serious side effects, even potentially fatal. Finally, the measures of QTd and cQTd confirmed additional electrocardiographic parameters useful in identifying patients being treated with drugs at risk of potential adverse arrhythmic events following drug interaction.Keywords
This publication has 19 references indexed in Scilit:
- Azithromycin, a 15-membered macrolide antibiotic, inhibits influenza A(H1N1)pdm09 virus infection by interfering with virus internalization processThe Journal of Antibiotics, 2019
- Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from ScotlandEuropean Respiratory Journal, 2018
- Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to HydroxychloroquineCase Reports in Cardiology, 2016
- Prevalence of QT Interval Prolongation in Patients Admitted to Cardiac Care Units and Frequency of Subsequent Administration of QT Interval-Prolonging DrugsDrug Safety, 2012
- Prevention of Torsade de Pointes in Hospital Settings: A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation Endorsed by the American Association of Critical-Care Nurses and the International Society for Computerized ElectrocardiologyJournal of Invasive Cardiology, 2010
- The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosusArthritis & Rheumatism, 2010
- Droperidol and Ondansetron-induced QT Interval ProlongationAnesthesiology, 2008
- Chronic Hydroxychloroquine Use Associated with QT Prolongation and Refractory Ventricular ArrhythmiaClinical Toxicology, 2006
- Effects of chloroquine on viral infections: an old drug against today's diseasesThe Lancet Infectious Diseases, 2003
- Measurement, interpretation and clinical potential of QT dispersionJournal of Invasive Cardiology, 2000