Semedo Edimir, Kapel Gijs F, van Opstal Jurren, van Dessel Pascal F H M
Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands.
Eur Heart J Case Rep. 2020 Jul 21;4(FI1):1-5. doi: 10.1093/ehjcr/ytaa218. eCollection 2020 Oct.
Early studies have led to the repositioning of a subgroup of antimalarial agents (e.g. chloroquine and hydroxychloroquine) as antiviral treatment in coronavirus disease 2019 (COVID-19) patients. These drugs are now being prescribed based on small non-controlled studies, but larger controlled studies have yet to demonstrate the positive effect of these drugs. In addition, these drugs are also known for their QT interval-prolonging effect associated with significant morbidity and mortality.
We present a case of a 66-year-old female admitted to the intensive care unit with respiratory failure due to COVID-19. She was treated with chloroquine (QTc interval at baseline was 429 ms). Despite cessation of chloroquine, but after the start of erythromycin, she developed severe QTc interval prolongation (QTc interval 550 ms) and 'Torsade de Pointes'. Two weeks after cessation of all QTc interval-prolonging drugs, the QTc interval was restored.
The elimination half-life of chloroquine ranges from days up to weeks. Even after discontinuation of chloroquine, ECG monitoring in COVID-19 patients is warranted. We recommend observation of the QT interval after cessation of chloroquine in cases where other potentially QT interval-prolonging drugs are introduced.
早期研究已促使将一类抗疟药（如氯喹和羟氯喹）重新定位为2019冠状病毒病（COVID-19）患者的抗病毒治疗药物。目前这些药物是根据小型非对照研究来开具处方的，但更大规模的对照研究尚未证实这些药物的积极效果。此外，这些药物还因其延长QT间期的作用而闻名，这与显著的发病率和死亡率相关。
我们报告一例66岁女性患者，因COVID-19导致呼吸衰竭入住重症监护病房。她接受了氯喹治疗（基线QTc间期为429毫秒）。尽管停用了氯喹，但在开始使用红霉素后，她出现了严重的QTc间期延长（QTc间期为550毫秒）并发生了“尖端扭转型室速”。在停用所有延长QT间期的药物两周后，QTc间期恢复正常。
氯喹的消除半衰期从数天到数周不等。即使在停用氯喹后，对COVID-19患者进行心电图监测也是必要的。我们建议在引入其他可能延长QT间期的药物时，在停用氯喹后观察QT间期。
