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Multicenter Study
. 2020 Dec 23;22(12):1855-1863.
doi: 10.1093/europace/euaa216.

Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings

Alessio Gasperetti  1   2 , Mauro Biffi  3 , Firat Duru  2 , Marco Schiavone  4 , Matteo Ziacchi  3 , Gianfranco Mitacchione  4 , Carlo Lavalle  5 , Ardan Saguner  2 , Antonio Lanfranchi  4 , Giacomo Casalini  6 , Marco Tocci  5 , Davide Fabbricatore  7 , Francesca Salghetti  7 , Marco Valerio Mariani  5 , Mattia Busana  8 , Alfonso Bellia  9 , Chiara Beatrice Cogliati  10 , Pierluigi Viale  1   11 , Spinello Antinori  6 , Massimo Galli  6 , Nazzareno Galiè  3 , Claudio Tondo  1   12 , Giovanni Battista Forleo  4
Affiliations
Multicenter Study

Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings

Alessio Gasperetti et al. Europace. .

Abstract

Aims: The aim of the study was to describe ECG modifications and arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in different clinical settings.

Methods and results: COVID-19 patients at seven institutions receiving HCQ therapy from whom a baseline and at least one ECG at 48+ h were available were enrolled in the study. QT/QTc prolongation, QT-associated and QT-independent arrhythmic events, arrhythmic mortality, and overall mortality during HCQ therapy were assessed. A total of 649 COVID-19 patients (61.9 ± 18.7 years, 46.1% males) were enrolled. HCQ therapy was administrated as a home therapy regimen in 126 (19.4%) patients, and as an in-hospital-treatment to 495 (76.3%) hospitalized and 28 (4.3%) intensive care unit (ICU) patients. At 36-72 and at 96+ h after the first HCQ dose, 358 and 404 ECGs were obtained, respectively. A significant QT/QTc interval prolongation was observed (P < 0.001), but the magnitude of the increase was modest [+13 (9-16) ms]. Baseline QT/QTc length and presence of fever (P = 0.001) at admission represented the most important determinants of QT/QTc prolongation. No arrhythmic-related deaths were reported. The overall major ventricular arrhythmia rate was low (1.1%), with all events found not to be related to QT or HCQ therapy at a centralized event evaluation. No differences in QT/QTc prolongation and QT-related arrhythmias were observed across different clinical settings, with non-QT-related arrhythmias being more common in the intensive care setting.

Conclusion: HCQ administration is safe for a short-term treatment for patients with COVID-19 infection regardless of the clinical setting of delivery, causing only modest QTc prolongation and no directly attributable arrhythmic deaths.

Keywords: Arrhythmias; COVID-19; Hydroxychloroquine; QT interval; SARS-CoV-2.

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Figures

Figure 1
Figure 1
QT/QTc distribution at T0 (upper panels) and at the last available ECG (lower panels) on hydroxychloroquine for the cohort. (A1/A2) QT interval (ms); (B1/B2) QTc Bazett (ms); (C1/C2) QTc Fridericia (ms); (D1/D2) QTc Framingham (ms).
Figure 2
Figure 2
Linear correlation between baseline QT/QTc (ms) and QT/QTc variations (ΔQT/ΔQTc) (ms). (A) QT interval; (B) QTc Bazett; (C) QTc Fridericia; (D) QTc Framingham
See this image and copyright information in PMC

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