Gunay S, Caliskan S, Sigirli D, Sahin E
Bratisl Lek Listy. 2020;121(11):817-821. doi: 10.4149/BLL_2020_134.
Combination of hydroxychloroquine and azithromycin for the treatment of coronavirus disease 2019 (COVID-19) carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias.
To characterize the ventricular repolarization indexes which are associated with malignant ventricular arrhythmias in patients treated with hydroxychloroquine and concomitant azithromycin for COVID-19.
A total of 81 patients who had hydroxychloroquine and azithromycin combination therapy because of possible or reverse-transcription polymertase chain reaction (RT-PCR) confirmed diagnosis of COVID-19 were included in the study. Baseline and control electrocardiograms (before and after treatment) were analyzed retrospectively. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios, which are ventricular repolarization indexes, were calculated.
While there was no significant increase in QTc interval in patients receiving combination therapy, there was a significant increase in ventricular repolarization indexes.
The increase in ventricular replarization indexes is associated with the risk of arrhythmia. In patients using QTc prolonging medication for COVID-19 treatment, QTc monitoring alone may not be sufficient to follow-up for arrhythmia. Even if there is no prolongation in QTc, an increase in ventricular repolarization indexes may be seen (Tab. 5, Ref. 37).
羟氯喹啉与阿奇霉素联合用于治疗2019冠状病毒病（COVID-19）会增加校正QT（QTc）延长和心律失常的风险。
明确在因COVID-19接受羟氯喹啉和阿奇霉素联合治疗的患者中，与恶性室性心律失常相关的心室复极指标。
本研究纳入了81例因可能感染或经逆转录聚合酶链反应（RT-PCR）确诊为COVID-19而接受羟氯喹啉和阿奇霉素联合治疗的患者。回顾性分析基线及对照心电图（治疗前后）。计算心室复极指标Tp-e间期、Tp-e/QT及Tp-e/QTc比值。
接受联合治疗的患者QTc间期无显著增加，但心室复极指标有显著增加。
心室复极指标增加与心律失常风险相关。在使用可延长QTc的药物治疗COVID-19的患者中，仅监测QTc可能不足以对心律失常进行随访。即使QTc无延长，也可能出现心室复极指标增加（表5，参考文献37）。
