QTc interval prolongation in patients infected with SARS-CoV-2 and treated with antiviral drugs
© 2021 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría..
Introduction: Many antiviral agents, such as hydroxychloroquine, have been used to treat COVID-19, without being broadly accepted. QTc prolongation is a worrisome adverse effect, scarcely studied in pediatrics.
Patients and methods: Pediatric patients affected from COVID-19 who received antivirals were matched (1:2) with controls not infected nor exposed. Electrocardiograms were prospectively analyzed at baseline, during the first 72 h in treatment and after 72 h.
Results: Eleven (22.9%) out of 48 patients admitted due to COVID-19 (March-July 2020) received antiviral therapy. All had underlying diseases: congenital heart disease (4/11; 36.4%) and immunosuppression (3/11; 27.3%) stand out. 5/11 (45.5%) received treatment at baseline with a potential effect on QTc. There where no differences observed in the baseline QTc between cases and controls: 414.8 ms (49.2) vs. 416.5 ms (29.4) (p = 0.716). Baseline long QT was observed in 2/11 cases and 2/22. Among cases, 10/11 (90.9%) received hydroxychloroquine, mainly associated with azithromycin (8/11; 72.7%), 3 received lopinavir/ritonavir and one remdesivir. The median increase in QTc after 72 h under treatment was 28.9 ms (IQR 48.7) (p = 0.062). 4/11 (36.4%) patients had a long QTc at 72 h, resulting in 3 patients ≥500 ms; treatment was stopped in one (QTc 510 ms) but ventricular arrhythmias were not documented.
Conclusions: The use of antivirals caused an increase on the QTc interval after 72 h of treatment, being the QTc long in 36.3% of the patients, although no arrhythmic events were observed. The use of hydroxychloroquine and antivirals requires active QTc monitoring and it is recommended to discontinue treatment if QTc >500 ms.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:96 |
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| Enthalten in: |
Anales de pediatria (Barcelona, Spain : 2003) - 96(2022), 3 vom: 30. März, Seite 213-220 |
| Sprache: |
Spanisch |
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| Weiterer Titel: |
Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales |
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| Beteiligte Personen: |
Esmel-Vilomara, Roger [VerfasserIn] |
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| Links: |
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| Themen: |
Azithromycin |
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| Anmerkungen: |
Date Revised 16.07.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.anpedi.2021.04.009 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325468176 |
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| 245 | 1 | 0 | |a QTc interval prolongation in patients infected with SARS-CoV-2 and treated with antiviral drugs |
| 246 | 3 | 3 | |a Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Revised 16.07.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2021 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría. | ||
| 520 | |a Introduction: Many antiviral agents, such as hydroxychloroquine, have been used to treat COVID-19, without being broadly accepted. QTc prolongation is a worrisome adverse effect, scarcely studied in pediatrics | ||
| 520 | |a Patients and methods: Pediatric patients affected from COVID-19 who received antivirals were matched (1:2) with controls not infected nor exposed. Electrocardiograms were prospectively analyzed at baseline, during the first 72 h in treatment and after 72 h | ||
| 520 | |a Results: Eleven (22.9%) out of 48 patients admitted due to COVID-19 (March-July 2020) received antiviral therapy. All had underlying diseases: congenital heart disease (4/11; 36.4%) and immunosuppression (3/11; 27.3%) stand out. 5/11 (45.5%) received treatment at baseline with a potential effect on QTc. There where no differences observed in the baseline QTc between cases and controls: 414.8 ms (49.2) vs. 416.5 ms (29.4) (p = 0.716). Baseline long QT was observed in 2/11 cases and 2/22. Among cases, 10/11 (90.9%) received hydroxychloroquine, mainly associated with azithromycin (8/11; 72.7%), 3 received lopinavir/ritonavir and one remdesivir. The median increase in QTc after 72 h under treatment was 28.9 ms (IQR 48.7) (p = 0.062). 4/11 (36.4%) patients had a long QTc at 72 h, resulting in 3 patients ≥500 ms; treatment was stopped in one (QTc 510 ms) but ventricular arrhythmias were not documented | ||
| 520 | |a Conclusions: The use of antivirals caused an increase on the QTc interval after 72 h of treatment, being the QTc long in 36.3% of the patients, although no arrhythmic events were observed. The use of hydroxychloroquine and antivirals requires active QTc monitoring and it is recommended to discontinue treatment if QTc >500 ms | ||
| 650 | 4 | |a English Abstract | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Azithromycin | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Child | |
| 650 | 4 | |a Electrocardiography | |
| 650 | 4 | |a Hydroxychloroquine | |
| 650 | 4 | |a Long QT syndrome | |
| 650 | 4 | |a Lopinavir | |
| 650 | 4 | |a Remdesivir | |
| 650 | 4 | |a Ritonavir | |
| 650 | 4 | |a SARS-CoV-2 | |
| 700 | 1 | |a Dolader, Paola |e verfasserin |4 aut | |
| 700 | 1 | |a Sabaté-Rotes, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Soriano-Arandes, Antoni |e verfasserin |4 aut | |
| 700 | 1 | |a Gran, Ferran |e verfasserin |4 aut | |
| 700 | 1 | |a Rosés-Noguer, Ferran |e verfasserin |4 aut | |
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