Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.
IRCCS Centro Cardiologico Monzino, Milan, Italy.
Curr Rev Clin Exp Pharmacol. 2021;16(4):306-317. doi: 10.2174/1574884715666201224155042.
While facing potentially high morbidity from COVID-19 without known effective therapies, the off-label use of several non-specific drugs has been advocated, including re-purposed anti- viral (e.g., remdesivir or the lopinavir/ritonavir combination), biologic agents (e.g., tocilizumab), and antimalarial drugs such as chloroquine and hydroxychloroquine, in association with or without azithromycin. Data regarding the effectiveness of these drugs in treating COVID-19 has been shown in some trials and clinical settings, but further randomised controlled trials are still being carried out. One of the main concerns regarding their widespread use, however, is their possible effects on the QT interval and arrhythmogenic potential. Some of these drugs have been associated with QT prolongation and Torsades de Point, a potentially lethal ventricular arrhythmia. The review aims to highlight the magnitude of this problem, to quickly refresh clinically impacting cornerstones of QT interval and TdP pathophysiology, to summarize the available evidence regarding the QT and arrhythmia impact of drugs used in different clinical settings in COVID-19 patients, and to help the physicians dealing with the knowledge needed in the everyday clinical duties in case of doubts regarding QT-induced arrhythmias in this time of emergency.
在面临 COVID-19 高发病率且缺乏已知有效治疗方法的情况下，已提倡使用几种非特异性药物进行标签外使用，包括重新定位的抗病毒药物（例如瑞德西韦或洛匹那韦/利托那韦联合用药）、生物制剂（例如托珠单抗）和抗疟药物如氯喹和羟氯喹，联合或不联合阿奇霉素。一些试验和临床环境中已经显示出这些药物在治疗 COVID-19 方面的有效性，但仍在进行进一步的随机对照试验。然而，广泛使用这些药物的主要关注点之一是它们对 QT 间期和致心律失常潜力的可能影响。其中一些药物与 QT 延长和尖端扭转型室性心动过速（一种潜在致命的室性心律失常）有关。该综述旨在强调这个问题的严重性，快速复习影响 QT 间期和尖端扭转型室性心动过速病理生理学的临床相关基石，总结在 COVID-19 患者的不同临床环境中使用的药物对 QT 和心律失常影响的现有证据，并帮助医生在处理日常临床职责时掌握在紧急情况下出现 QT 诱导的心律失常时所需的知识。
