Department of Cardiology, University Hospital of León, León, Spain.
Department of Cardiology, University Hospital of León, León, Spain.
J Electrocardiol. 2021 Jan-Feb;64:30-35. doi: 10.1016/j.jelectrocard.2020.11.012. Epub 2020 Nov 28.
Administration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied.
Our aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality.
Patients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy.
168 patients (±66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series.
DT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.
羟氯喹和阿奇霉素联合治疗 2019 年冠状病毒病（COVID-19）会延长校正 QT 间期（QTc）。洛匹那韦/利托那韦联合这些疗法的效果和安全性鲜有研究。
我们旨在评估 COVID-19 患者接受羟氯喹+阿奇霉素双联（DT）和羟氯喹+阿奇霉素+洛匹那韦/利托那韦三联（TT）治疗时 QTc 的变化。次要终点是院内全因死亡率。
连续纳入接受 DT 和 TT 治疗 COVID-19 的患者，前瞻性观察研究。入院期间连续行心电图以测量 QTc 基线值和治疗期间值。
共纳入 168 例患者（±66.2 岁）：32.1%接受 DT，67.9%接受 TT。基线 QTc 平均为 410.33 ms。DT 和 TT 组均较基线值延长 QTc 间期（p < 0.001），但两组间无显著差异（p = 0.748）。总体而言，33 例（19.6%）患者 QTc 峰值和/或较基线值增加≥60 ms，低钾血症患者中更常见（p = 0.003）。两组间全因死亡率无差异（p = 0.093），且本研究系列中高危 QTc 延长与临床事件无关。
DT 和 TT 均会延长 COVID-19 患者的 QTc。与 DT 相比，在羟氯喹和阿奇霉素的基础上加用洛匹那韦/利托那韦并未进一步增加 QTc。
