Walia Rohit, Prabhakaran Nanda, Kodliwadmath Ashwin, Singh O Buddha Charan, Mahala Prakash, Kaeley Nidhi
Department of Cardiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India.
Department of Cardiac Electrophysiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India.
J Family Med Prim Care. 2022 Apr;11(4):1514-1518. doi: 10.4103/jfmpc.jfmpc_1369_21. Epub 2022 Mar 18.
The use of hydroxychloroquine (HCQ) for COVID-19 treatment and prophylaxis raised issues concerning its cardiac safety owing to the possibility of QT prolongation and arrhythmias. There was no study on long-term electrocardiographic telemetry monitoring of patients taking HCQ. We planned a continuous electrocardiographic Holter telemetry of these patients for 7 days.
Health care workers taking HCQ as pre exposure prophylaxis and patients on HCQ were monitored using seven day Holter electrocardiographic telemetry with continuous beat to beat analysis. Telemetry can instantly convey any arrhythmic event or significant QT prolongation to the medical faculty.
Twenty-five participants with a mean age of 42.4 ± 14.1 years were included in the study; 40% were females. Twenty percent of participants needed to stop HCQ. Four patients developed QT prolongation >500 ms and needed to stop HCQ, one patient had accelerated idioventricular rhythm and stopped treatment, and one had short episodes of atrial fibrillation. No malignant arrhythmia or ventricular arrhythmia, or torsade de pointis were noted. No episode of significant conduction disturbance and arrhythmic death was noted. Baseline mean QTc was 423.96 ± 32.18 ms, mean QTc corrected at 24 h was 438.93 ± 37.95, mean QTc was 451.879 ± 37.99 at 48 h, and change in baseline mean QTc to max QTc was 30.74 ± 21.75 ms at 48 h. All those who developed QTc prolongation >500 ms were greater than 50 years of age.
Ambulatory telemetry ECG monitoring detects early QT prolongation, and stopping drugs prevents malignant arrhythmias. HCQ seems to have less risk of QT prolongation in young, healthy individuals.
由于羟氯喹（HCQ）存在导致QT间期延长和心律失常的可能性，其用于治疗和预防2019冠状病毒病（COVID-19）引发了关于其心脏安全性的问题。此前尚无针对服用HCQ患者的长期心电图遥测监测研究。我们计划对这些患者进行为期7天的连续心电图动态监测。
对将HCQ用作暴露前预防药物的医护人员以及服用HCQ的患者，使用为期7天的动态心电图遥测进行监测，并进行逐搏连续分析。遥测可即时将任何心律失常事件或显著的QT间期延长情况传达给医务人员。
本研究纳入了25名平均年龄为42.4±14.1岁的参与者；40%为女性。20%的参与者需要停用HCQ。4名患者QT间期延长>500毫秒，需要停用HCQ，1名患者出现加速性室性自主心律并停止治疗，1名患者有短暂心房颤动发作。未发现恶性心律失常或室性心律失常，也未发现尖端扭转型室性心动过速。未观察到显著传导障碍和心律失常性死亡事件。基线平均QTc为423.96±32.18毫秒，24小时校正后的平均QTc为438.93±37.95，48小时时平均QTc为451.879±37.99，48小时时基线平均QTc至最大QTc的变化为30.74±21.75毫秒。所有QT间期延长>500毫秒的患者年龄均大于50岁。
动态心电图遥测监测可检测到早期QT间期延长，停药可预防恶性心律失常。在年轻、健康个体中，HCQ导致QT间期延长的风险似乎较低。
