Abstract
Background: We described the QTc interval prolongation and related
adverse cardiac events during the administration of hydroxychloroquine
(HCQ) and its combinations for treatment of COVID-19. Methods: The
hospitalized patients who were infected with SARS-CoV-2 and received HCQ
with initial and follow up ECGs from March 10th to May 30th were
included. The critical QTc prolongation was accepted as QTc
>500 ms if QRS<120ms and >550 ms if
QRS >120 ms or ∆QTc levels >60 ms when
compared with the initial ECG. Primary outcomes were critical QTc
prolongation, ventricular tachyarrhythmia, and sudden cardiac arrest.
Results: Out of 336 hospitalized patients with suspected or confirmed
COVID-19, 297 received HCQ, and 94 met the inclusion criteria, and 66
cases were included in final analysis. The mean baseline QTc was 444.5
(sd= 39.5) ms. In total, 63% of the patients’ QTc levels increased
under HCQ treatment and critical QTc prolongation occurred in 8 cases
(12%) all of whom were male. The male gender (p=0.033), DM (p=0.035)
and oseltamivir use (p=0.047) were significantly associated with
critical QTc prolongation. In multivariate analysis, DM (OR:5.8, %95
Cl:1.11-30.32, p:0.037), and concomitant use of oseltamivir (OR:5.3,
%95 Cl:1,02-28, p:0.047) were found to be associated with critical QTc
prolongation. Conclusion: Critical QTc prolongation was detected in 12%
of the patients. The DM and concomitant oseltamivir use were associated
with critical QTc prolongation. The use of concurrent drugs that have
potential to enhance QTc interval should be kept in mind and special
attention should be paid for ECG monitoring.