Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 1;4(4):e216842.
doi: 10.1001/jamanetworkopen.2021.6842.

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic

Geoffrey A Rubin  1 , Amar D Desai  1 , Zilan Chai  2 , Aijin Wang  2 , Qixuan Chen  2 , Amy S Wang  3 , Cameron Kemal  4 , Haajra Baksh  1 , Angelo Biviano  1 , Jose M Dizon  1 , Hirad Yarmohammadi  1 , Frederick Ehlert  1 , Deepak Saluja  1 , David A Rubin  1 , John P Morrow  1 , Uma Mahesh R Avula  1 , Jeremy P Berman  1 , Alexander Kushnir  1 , Mark P Abrams  1 , Jessica A Hennessey  1 , Pierre Elias  1 , Timothy J Poterucha  1 , Nir Uriel  1 , Christine J Kubin  5 , Elijah LaSota  5 , Jason Zucker  5 , Magdalena E Sobieszczyk  5 , Allan Schwartz  1 , Hasan Garan  1 , Marc P Waase  1 , Elaine Y Wan  1
Affiliations

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic

Geoffrey A Rubin et al. JAMA Netw Open. .

Abstract

Importance: Critical illness, a marked inflammatory response, and viruses such as SARS-CoV-2 may prolong corrected QT interval (QTc).

Objective: To evaluate baseline QTc interval on 12-lead electrocardiograms (ECGs) and ensuing changes among patients with and without COVID-19.

Design, setting, and participants: This cohort study included 3050 patients aged 18 years and older who underwent SARS-CoV-2 testing and had ECGs at Columbia University Irving Medical Center from March 1 through May 1, 2020. Patients were analyzed by treatment group over 5 days, as follows: hydroxychloroquine with azithromycin, hydroxychloroquine alone, azithromycin alone, and neither hydroxychloroquine nor azithromycin. ECGs were manually analyzed by electrophysiologists masked to COVID-19 status. Multivariable modeling evaluated clinical associations with QTc prolongation from baseline.

Exposures: COVID-19, hydroxychloroquine, azithromycin.

Main outcomes and measures: Mean QTc prolongation, percentage of patients with QTc of 500 milliseconds or greater.

Results: A total of 965 patients had more than 2 ECGs and were included in the study, with 561 (58.1%) men, 198 (26.2%) Black patients, and 191 (19.8%) aged 80 years and older. There were 733 patients (76.0%) with COVID-19 and 232 patients (24.0%) without COVID-19. COVID-19 infection was associated with significant mean QTc prolongation from baseline by both 5-day and 2-day multivariable models (5-day, patients with COVID-19: 20.81 [95% CI, 15.29 to 26.33] milliseconds; P < .001; patients without COVID-19: -2.01 [95% CI, -17.31 to 21.32] milliseconds; P = .93; 2-day, patients with COVID-19: 17.40 [95% CI, 12.65 to 22.16] milliseconds; P < .001; patients without COVID-19: 0.11 [95% CI, -12.60 to 12.81] milliseconds; P = .99). COVID-19 infection was independently associated with a modeled mean 27.32 (95% CI, 4.63-43.21) millisecond increase in QTc at 5 days compared with COVID-19-negative status (mean QTc, with COVID-19: 450.45 [95% CI, 441.6 to 459.3] milliseconds; without COVID-19: 423.13 [95% CI, 403.25 to 443.01] milliseconds; P = .01). More patients with COVID-19 not receiving hydroxychloroquine and azithromycin had QTc of 500 milliseconds or greater compared with patients without COVID-19 (34 of 136 [25.0%] vs 17 of 158 [10.8%], P = .002). Multivariable analysis revealed that age 80 years and older compared with those younger than 50 years (mean difference in QTc, 11.91 [SE, 4.69; 95% CI, 2.73 to 21.09]; P = .01), severe chronic kidney disease compared with no chronic kidney disease (mean difference in QTc, 12.20 [SE, 5.26; 95% CI, 1.89 to 22.51; P = .02]), elevated high-sensitivity troponin levels (mean difference in QTc, 5.05 [SE, 1.19; 95% CI, 2.72 to 7.38]; P < .001), and elevated lactate dehydrogenase levels (mean difference in QTc, 5.31 [SE, 2.68; 95% CI, 0.06 to 10.57]; P = .04) were associated with QTc prolongation. Torsades de pointes occurred in 1 patient (0.1%) with COVID-19.

Conclusions and relevance: In this cohort study, COVID-19 infection was independently associated with significant mean QTc prolongation at days 5 and 2 of hospitalization compared with day 0. More patients with COVID-19 had QTc of 500 milliseconds or greater compared with patients without COVID-19.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Biviano reported serving as an advisory board member for Boston Scientific and Biosense Webster outside the submitted work. Dr Saluja reported receiving personal fees from Abbott and Biosense Webster outside the submitted work. Dr Poterucha reported owning stock in Abbvie, Abbott Laboratories, Edwards Lifesciences, and Baxter International and receiving grants from Eidos Therapeutics, Pfizer, and Amyloidosis Foundation outside the submitted work. Dr Uriel reported receiving personal fees from Abbott, Medtronic, and Livemetric and serving on the scientific advisory board of Leviticus outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Linear Modeled Corrected QT Interval (QTc) Patterns Between Patients With and Without COVID-19
See this image and copyright information in PMC

References

    1. US Centers for Disease Control and Prevention . COVID-19. Accessed July 20, 2020. https://www.cdc.gov/coronavirus/2019-nCoV/index.html
    1. Group RC, Horby P, Lim WS, et al. . Dexamethasone in hospitalized patients with COVID-19—preliminary report. N Engl J Med 2021;384(8):693-704. doi:10.1056/NEJMoa2021436 - DOI - PMC - PubMed
    1. Beigel JH, Tomashek KM, Dodd LE, et al. ; ACTT-1 Study Group Members . Remdesivir for the treatment of COVID-19—final report. N Engl J Med. 2020;383(19):1813-1826. doi:10.1056/NEJMoa2007764 - DOI - PMC - PubMed
    1. Gautret P, Lagier JC, Parola P, et al. . Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):105949. doi:10.1016/j.ijantimicag.2020.105949 - DOI - PMC - PubMed
    1. Shehab N, Lovegrove M, Budnitz DSUS. US hydroxychloroquine, chloroquine, and azithromycin outpatient prescription trends, October 2019 through March 2020. JAMA Intern Med. 2020;180(10):1384-1386. doi:10.1001/jamainternmed.2020.2594 - DOI - PMC - PubMed

Publication types

MeSH terms