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. 2020 Aug 19;32(3):350-357.
doi: 10.37616/2212-5043.1088. eCollection 2020.

Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability

Amal El Ouarradi  1 , Salma Abdeladim  1 , Sara Oualim  1 , Rita Aniq Filali  2 , Ilham Bensahi  1 , Mahassine Elharass  1 , Sara Hafid  1 , Hamza Tazi  1 , Abdelhamid Naitlhou  2 , El Arbi Bouaiti  3 , Abdelhamid Moustaghfir  1 , Mohamed Sabry  1
Affiliations

Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability

Amal El Ouarradi et al. J Saudi Heart Assoc. .

Abstract

During the COVID-19 pandemic, the effectiveness of the combination of hydroxychloroquine and azithromycin is widely discussed. This treatment can cause many severe cardiac side effects that makes us discuss its utility. The aim of this study is to describe the cardiovascular effect of hydroxychloroquine and azithromycin by analyzing surface ECG in patients with COVID-19. This observational cohort study included Moroccan patients with COVID-19 diagnosis and were hospitalized in Cheikh Khalifa International University Hospital, Casablanca, Morocco between March 26 and April 20, 2020. Patients were treated with a combination of hydroxychloroquine and azithromycin over a period of at least ten days. We were interested in the effects of this combination on the electrocardiogram. A total of 118 eligible patients were enrolled in the study. QT interval prolongation was observed in 19% of patients under the treatment. Only 5 patients required discontinuation of treatment. The factors associated with QT prolongation are male gender (P value 0,043), age over 68 years (P value 0,09), cardiovascular comorbidity (P value 0,013), tisdale score ≥11 (P value < 0,001), and a severe form of COVID-19 (P value < 0,001). First degree atrioventricular block was observed in 2 patients. No serious rhythm or conduction disorders were observed in this study. QT prolongation is a real risk with the combination of hydroxychloroquine and azithromycin. In the current context, it is necessary to select patients at high risk of severe rhythm disturbances that require closer ECG monitoring. Treatment should be discontinued if there are alarming signs such as QTc prolongation beyond 550 ms and the development of ventricular extrasystole or torsade de pointe.

Keywords: Azithromycin; COVID-19; Electrocardiogram; Hydroxychloroquine; QT prolongation.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Individual changes in corrected QT (QTc) interval.
Fig. 2
Fig. 2
Protocol proposing for electrical monitoring of patients with COVID-19. QTc: corrected QT, VES: ventricular extrasystole, TdP: torsades de pointes.
See this image and copyright information in PMC

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