van den Broek M P H, Möhlmann J E, Abeln B G S, Liebregts M, van Dijk V F, van de Garde E M W
Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2020 Jul;28(7-8):406-409. doi: 10.1007/s12471-020-01429-7.
In the battle against the SARS-CoV‑2 pandemic, chloroquine has emerged as a new potential therapeutic option for the treatment of infected patients. A safety consideration for the application of chloroquine is its QTc-prolonging potential. Thus far, no data are available on the QTc-prolonging potential of chloroquine in COVID-19 patients.
To assess the degree of chloroquine-induced QTc prolongation in hospitalised COVID-19 patients.
A baseline electrocardiogram (ECG) and ECGs recorded during chloroquine treatment were retrospectively collected in patients suspected of having COVID-19. The QTc interval was calculated by computerised and manual interpretation. Baseline and follow-up QTc intervals were compared using the paired samples t-test.
A total of 95 patients had a baseline ECG recording and at least one ECG recording during chloroquine therapy. Chloroquine treatment resulted in a mean QTc prolongation of 35 ms (95% CI 28-43 ms) using computerised interpretation and 34 ms (95% CI 25-43 ms) using manual interpretation. No torsade de pointes was observed during chloroquine treatment. After manual review, 22 patients (23%) had a QTc interval exceeding 500 ms during chloroquine treatment. None of these patients had a prolonged QTc interval prior to the initiation of chloroquine treatment.
Chloroquine significantly prolongs the QTc interval in a clinically relevant matter. This highlights the need for ECG monitoring when prescribing chloroquine to COVID-19 patients.
在抗击新型冠状病毒肺炎疫情的战斗中，氯喹已成为治疗感染患者的一种新的潜在治疗选择。应用氯喹时的一个安全考量因素是其延长QTc间期的可能性。迄今为止，尚无关于氯喹在新型冠状病毒肺炎患者中延长QTc间期可能性的数据。
评估住院的新型冠状病毒肺炎患者中氯喹引起的QTc间期延长程度。
回顾性收集疑似新型冠状病毒肺炎患者的基线心电图以及氯喹治疗期间记录的心电图。通过计算机化和人工解读计算QTc间期。使用配对样本t检验比较基线和随访的QTc间期。
共有95例患者有基线心电图记录且在氯喹治疗期间至少有一次心电图记录。采用计算机化解读时，氯喹治疗导致QTc间期平均延长35毫秒（95%置信区间28 - 43毫秒），采用人工解读时为34毫秒（95%置信区间25 - 43毫秒）。氯喹治疗期间未观察到尖端扭转型室性心动过速。人工复查后，22例患者（23%）在氯喹治疗期间QTc间期超过500毫秒。这些患者在开始氯喹治疗前QTc间期均未延长。
氯喹在临床上显著延长QTc间期。这凸显了给新型冠状病毒肺炎患者开具氯喹时进行心电图监测的必要性。
