Absence of relevant QT interval prolongation in not critically ill COVID-19 patients
Abstract
Objectives
SARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients.
Design
We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 hours after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors.
Results
We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14,1 %) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation.
Conclusions
Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.
What is already known about this subject?
Treatment for COVID 19 with empirical drugs hydroxicloroquine, azitromycin and protease inhibitors affects ventricular repolarization by prolonging the QT interval in a variable degree basing upon heterogeneous studies
What does this study add?
Not critically ill patients with COVID 19 develop a non relevant QT interval prolongation, leading to a modest arrhythmic risk increase, overall in patients with normal basal ECG
How might this impact on clinical practice?
Our findings are significant as ECG monitoring of COVID 19 patients is costly and difficult. Ambulatory and stable patients with normal basal ECG might nor benefit from QT assessment afeter treatment initiation
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