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Effect of Covid-19 Medications on Corrected Qt Interval and Induction of Torsade De Pointes: Results of a Multicenter National Survey Publisher Pubmed



Haghjoo M1 ; Golipra R2 ; Kheirkhah J3 ; Golabchi A4 ; Shahabi J5 ; Oniheris S4 ; Sami R6 ; Tajmirriahi M7 ; Saravi M8 ; Khatami M9 ; Varnasseri M10 ; Kiarsi M11 ; Hejazi SF12 ; Yousefzadeh Rahaghi M12 Show All Authors
Authors
  1. Haghjoo M1
  2. Golipra R2
  3. Kheirkhah J3
  4. Golabchi A4
  5. Shahabi J5
  6. Oniheris S4
  7. Sami R6
  8. Tajmirriahi M7
  9. Saravi M8
  10. Khatami M9
  11. Varnasseri M10
  12. Kiarsi M11
  13. Hejazi SF12
  14. Yousefzadeh Rahaghi M12
  15. Taherkhani M13
  16. Ashraf H14
  17. Keshmiri MS15
  18. Akbarzadeh MA16
  19. Bozorgi A17
  20. Mottaghizadeh F16
  21. Hedayat B17
  22. Heidarali M2
  23. Hajhossein Talasaz A17
Show Affiliations
Authors Affiliations
  1. 1. Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
  4. 4. Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
  5. 5. Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  6. 6. Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  7. 7. Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
  8. 8. Clinical Research Development Unit, School of Medicine, Babol University of Medical Science, Babol, Iran
  9. 9. Imam Sajad Hospital, Iran University of Medical Sciences, Shahryar, Iran
  10. 10. Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  11. 11. Atherosclerosis Research Center, Ahvaz University of Medical Sciences, Ahvaz, Iran
  12. 12. Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
  13. 13. Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  14. 14. Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  15. 15. Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  16. 16. Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  17. 17. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

Source: International Journal of Clinical Practice Published:2021


Abstract

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP. © 2021 John Wiley & Sons Ltd.
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