Drug-induced ventricular arrhytmogenesis in patients with COVID-19. A literature review

Abstract

Introduction: Several existing medications are being repurposed for treatment of COVID-19, including chloroquine and hydroxychloroquine. The use of these medications has been associated with QT prolongation. Their use in patients with COVID-19, magnifies the risk for development of heart arrhythmias. Purpose: The aim of this bibliographic research was to perform an analysis of existing clinical reports regarding effects of chloroquine and hydroxychloroquine used in patients with COVID-19 on myocardial repolarization, effects which can be measured on ECG as dispersion of QT interval and manifested clinically as heart arrhythmias. Material and methods: A three‐step approach was employed. Firstly, a search of clinical reports in HINARI and PubMed using key words COVID-19 and QT dispersion was performed. Secondarily, selected articles were limited to the English language and human studies. Finally, full texts of all the selected articles were reviewed in details and points relevant to QT dispersion related to use of drugs were extracted. A number of 11 articles was selected for final analysis. Full information regarding age of patients, dosage of drugs used, information about changes in QTc, clinical outcomes were found in 7 articles, which analysis is presented in the table 1 and 2. Conclusions: Medications used in COVID-19 patients have the potential to affect electrophysiology of the heart and can be associated with QT dispersion on ECG. Giving importance to these ECG markers may have a significant contribution in decreasing drug-related arrhythmias in this group of patients. Chloroquine and hydroxychloroquine particularly when combined with azithromycin increase the QTc in patients. QTc prolongation is used as a surrogate of risk for torsades de pointes, but the relationship is imperfect. Risk generally increases when the QTc exceeds 500 ms. The amount of QTc increase varies with drug dose, drug combination, sex, underlying heart disease in addition to COVID-19.