González Nerea Torres, Acosta Luis Álvarez, Miranda Diego Valdivia, Plasencia Alejandro Iriarte, Cáceres Virginia Barreto, Zambrano Marx Rivera, Afonso Julio Salvador Hernández
Department of Cardiology, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain.
Division of Arrhythmia and Electrophysiology, Department of Cardiology, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain.
Int J Cardiol Heart Vasc. 2020 Oct;30:100644. doi: 10.1016/j.ijcha.2020.100644. Epub 2020 Sep 17.
Coronavirus Disease 2019 continues to spread and to date, no definitive treatment is available. Overcrowded and under-resourced healthcare centres have had to design different strategies to treat these patients, what includes the control of the electrocardiogram (ECG), as some drugs that have been used to treat this disease may prolong the QT interval as a side effect. During the COVID-19 outbreak, we designed a protocol for monitoring the QT interval using a portable device with Bluetooth connectivity. After a validation study with 50 patients, we found a very good correlation between the QT interval measured both with this device and with the conventional body surface ECG. In this article, we provide a brief overview of the protocol and then analyse the QT changes observed in a group of patients during their hospitalization and treatment for SARS-CoV-2 infection. 81 patients with confirmed SARS-CoV-2 infection were enrolled in the protocol (age 63.4 SD 17.2 years; 70.3% men), while being treated with lopinavir/ritonavir, azithromycin and hydroxychloroquine, both individually or combined. Ten patients developed long drug-related QT interval, and the QT prolongation was statically significant for all treatment schemes. All patients with drug induced QT prolongation corrected the QT interval following the indications of the protocol, and no patients died of arrhythmic causes after its implementation. In our experience, a protocol for the electrocardiographic monitoring of these patients minimizes the risk of iatrogenic QT interval prolongation and consequently reduces sudden death events, and for that purpose, portable devices like the one used in this protocol may constitute a useful tool to minimize the contact with such patients.
2019冠状病毒病仍在持续传播,迄今为止,尚无确切的治疗方法。医疗资源不足且过度拥挤的医疗中心不得不制定不同的策略来治疗这些患者,其中包括对心电图(ECG)的监测,因为一些用于治疗该疾病的药物可能会延长QT间期,这是其副作用之一。在新型冠状病毒肺炎疫情期间,我们设计了一种使用具有蓝牙连接功能的便携式设备监测QT间期的方案。在对50名患者进行验证研究后,我们发现该设备测量的QT间期与传统体表心电图测量的QT间期之间具有很好的相关性。在本文中,我们简要概述了该方案,然后分析了一组感染严重急性呼吸综合征冠状病毒2的患者在住院和治疗期间观察到的QT变化。81名确诊感染严重急性呼吸综合征冠状病毒2的患者参与了该方案(年龄63.4±17.2岁;男性占70.3%),他们单独或联合使用洛匹那韦/利托那韦、阿奇霉素和羟氯喹进行治疗。10名患者出现了与药物相关的长QT间期,并且所有治疗方案的QT延长在统计学上均具有显著性。所有药物性QT延长的患者按照方案的指示纠正了QT间期,并且在实施该方案后没有患者死于心律失常原因。根据我们的经验,对这些患者进行心电图监测的方案可将医源性QT间期延长的风险降至最低,从而减少猝死事件,为此,本方案中使用的便携式设备可能是减少与这类患者接触的有用工具。