Experience With Hydroxychloroquine and Azithromycin in the Coronavirus Disease 2019 Pandemic: Implications for QT Interval Monitoring

• Published in: Journal of the American Heart Association 2020-06, Vol.9 (12), p.e017144
• Main Authors: Ramireddy, Archana, Chugh, Harpriya, Reinier, Kyndaron, Ebinger, Joseph, Park, Eunice, Thompson, Michael, Cingolani, Eugenio, Cheng, Susan, Marban, Eduardo, Albert, Christine M, Chugh, Sumeet S
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antimalarials - therapeutic use; azithromycin; Azithromycin - therapeutic use; Betacoronavirus; Coronavirus Infections - complications; Coronavirus Infections - drug therapy; COVID-19; Drug Therapy, Combination; Electrocardiography - drug effects; Female; Humans; hydroxychloroquine; Hydroxychloroquine - therapeutic use; Long QT Syndrome - chemically induced; Long QT Syndrome - physiopathology; Male; Middle Aged; monitoring; Original Research; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - drug therapy; Prognosis; QT interval; Risk Factors; SARS-CoV-2
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.017144

Background Despite a lack of clinical evidence, hydroxychloroquine and azithromycin are being administered widely to patients with verified or suspected coronavirus disease 2019 (COVID-19). Both drugs may increase risk of lethal arrhythmias associated with QT interval prolongation. Methods and Results We analyzed a case series of COVID-19-positive/suspected patients admitted between February 1, 2020, and April 4, 2020, who were treated with azithromycin, hydroxychloroquine, or a combination of both drugs. We evaluated baseline and postmedication QT interval (corrected QT interval [QTc]; Bazett) using 12-lead ECGs. Critical QTc prolongation was defined as follows: (1) maximum QTc ≥500 ms (if QRS