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1.
Pan Afr Med J ; 40: 67, 2021.
Article in English | MEDLINE | ID: covidwho-1497893

ABSTRACT

Adverse consequences of the coronavirus disease 2019 (COVID-19) vaccination which have been reported in scientific papers are varied. One possible but rare consequence is myocarditis, which may have a diversity of clinical manifestations. We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , Long QT Syndrome/etiology , Syncope/etiology , Aged , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Electrocardiography , Humans , Long QT Syndrome/diagnosis , Long QT Syndrome/drug therapy , Magnesium/administration & dosage , Male , Myocarditis/diagnosis , Myocarditis/etiology , Syncope/diagnosis , Vaccination/adverse effects , Vaccination/methods
2.
Cardiol Young ; 31(3): 344-351, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1101608

ABSTRACT

The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , COVID-19/drug therapy , Heart Defects, Congenital/therapy , Immunologic Factors/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Brugada Syndrome/drug therapy , Brugada Syndrome/epidemiology , Brugada Syndrome/physiopathology , COVID-19/epidemiology , COVID-19/physiopathology , Cardiac Surgical Procedures , Cardiology , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/physiopathology , Heart Transplantation , Humans , Infectious Disease Transmission, Vertical , Long QT Syndrome/drug therapy , Long QT Syndrome/epidemiology , Long QT Syndrome/physiopathology , Myocarditis/epidemiology , Myocarditis/physiopathology , Myocardium , Pediatrics , Risk Assessment , SARS-CoV-2 , Societies, Medical , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/physiopathology , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/epidemiology , Tachycardia, Ventricular/physiopathology
3.
Int J Cardiol ; 324: 242-248, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1065146

ABSTRACT

BACKGROUND: Hydroxychloroquine (HCQ) and azithromycin (AZT) have been proposed for COVID-19 treatment. Data available in the literature reported a potential increased risk of fatal arrhythmias under these therapies. The aim of this study was to assess the effects of these drugs on QT interval and outcome in a COVID-19 population. METHOD: A total of 112 consecutive COVID-19 patients were included in this analysis and were divided in 3 groups according to the receiving therapeutic regimens: 19 (17%) patients in Group 1 (no treatment), 40 (36%) in Group 2 (HCQ only), 53 (47%) in Group 3 (HCQ/AZT). RESULTS: A prolonged QTc interval was found in 61% of patients treated with HCQ alone or in combination with AZT, but only 4 (4%) patients showed a QTc > 500 ms. HCQ/AZT combination determined a greater increase of QTc duration compared to the other two strategies (Group 3 452 ± 26.4 vs Group 2 436.3 ± 28.4 vs Group 1 424.4 ± 24.3 ms, respectively; p < 0.001). Multivariate analysis demonstrated that HCQ/AZT combination (OR 9.02, p = 0.001) and older age (OR 1.04, p = 0.031) were independent predictors of QTc prolongation. The risk increased with age (incremental utility analysis p = 0.02). Twenty patients (18%) died, and no cardiac arrest neither arrhythmic fatalities were documented. CONCLUSIONS: The HCQ/AZT combination therapy causes a significantly increase of QT interval compared to HCQ alone. Older patients under such regimen are at higher risk of experiencing QT prolongation. The use of such drugs may be considered as safe relating to arrhythmic risk in the treatment of COVID-19 patients as no arrhythmic fatalities occurred.


Subject(s)
Azithromycin/administration & dosage , Azithromycin/adverse effects , COVID-19/chemically induced , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Long QT Syndrome/drug therapy , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Antimalarials/administration & dosage , Antimalarials/adverse effects , COVID-19/diagnosis , COVID-19/physiopathology , Drug Therapy, Combination , Electrocardiography/drug effects , Electrocardiography/trends , Female , Follow-Up Studies , Humans , Long QT Syndrome/diagnosis , Male , Middle Aged , Patient Safety , Retrospective Studies
4.
Int J Clin Pract ; 75(2): e13896, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1010920

ABSTRACT

BACKGROUND: Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. METHODS: This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. RESULTS: Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 ± 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P < .001). However, HCQ + AZM combination group had significantly higher ΔQTc compared to HCQ group (22.5 ± 18.4 vs 7.5 ± 15.3 ms, P < .001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. CONCLUSIONS: The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Azithromycin/therapeutic use , COVID-19/drug therapy , Hydroxychloroquine/therapeutic use , Long QT Syndrome/drug therapy , Adult , Aged , Arrhythmias, Cardiac/epidemiology , COVID-19/epidemiology , Comorbidity , Drug Therapy, Combination , Electrocardiography , Female , Humans , Long QT Syndrome/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
5.
Int J Clin Pract ; 75(3): e13767, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-991403

ABSTRACT

BACKGROUND: The liberal administration of hydroxychloroquine-sulphate (HCQ) to COVID-19 patients has raised concern regarding the risk of QTc prolongation and cardiac arrhythmias, particularly when prescribed with azithromycin. We evaluated the incidence of QTc prolongation among moderately and severely ill COVID-19 patients treated with HCQ and of the existence of concomitant alternative causes. METHODS: All COVID-19 patients treated with HCQ (between Mar 1 and Apr 14, 2020) in a tertiary medical centre were included. Clinical characteristics and relevant risk factors were collected from the electronic medical records. Individual patient QTc intervals were determined before and after treatment with HCQ. The primary outcome measure sought was a composite end point comprised of either an increase ≥60 milliseconds (ms) in the QTc interval compared with pre-treatment QTc, and/or a maximal QTc interval >500 ms RESULTS: Ninety patients were included. Median age was 65 years (IQR 55-75) and 57 (63%) were male. Thirty-nine patients (43%) were severely or critically ill. Hypertension and obesity were common (n = 23 each, 26%). QTc prolongation evolved in 14 patients (16%). Age >65 years, congestive heart failure, severity of disease, C-reactive protein level, hypokalaemia and furosemide treatment, were all associated with QTc prolongation. Adjusted analysis showed that QTc prolongation was five times more likely with hypokalaemia [OR 5, (95% CI, 1.3-20)], and three times more likely with furosemide treatment [OR 3 (95% CI, 1.01-13.7)]. CONCLUSION: In patients treated with HCQ, QTc prolongation was associated with the presence of traditional risk factors such as hypokalaemia and furosemide treatment.


Subject(s)
COVID-19 , Long QT Syndrome , Aged , Azithromycin , COVID-19/drug therapy , Drug Therapy, Combination , Electrocardiography , Female , Humans , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Long QT Syndrome/drug therapy , Male , SARS-CoV-2
6.
J Investig Med High Impact Case Rep ; 8: 2324709620948407, 2020.
Article in English | MEDLINE | ID: covidwho-695218

ABSTRACT

Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.


Subject(s)
Betacoronavirus , Coronavirus Infections/physiopathology , Long QT Syndrome/physiopathology , Pneumonia, Viral/physiopathology , Tachycardia, Ventricular/physiopathology , Aged , Azithromycin/therapeutic use , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diet therapy , Coronavirus Infections/drug therapy , Coronavirus Infections/metabolism , Fatal Outcome , Female , Humans , Hydroxychloroquine/therapeutic use , Long QT Syndrome/drug therapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diet therapy , SARS-CoV-2 , Tachycardia, Ventricular/etiology
7.
J Interv Card Electrophysiol ; 59(2): 337-345, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-640049

ABSTRACT

PURPOSE: Hydroxychloroquine, chloroquine, and azithromycin have been used for treatment of COVID-19, but may cause QT prolongation. Minority populations are disproportionately impacted by COVID-19. This study evaluates the risk of QT prolongation and subsequent outcomes after administration of these medications in largely underrepresented minority COVID-19 patients. METHODS: We conducted an observational study on hospitalized COVID-19 patients in the Montefiore Health System (Bronx, NY). We examined electrocardiograms (ECG) pre/post-medication initiation to evaluate QTc, HR, QRS duration, and presence of other arrhythmias. RESULTS: One hundred five patients (mean age 67 years; 44.8% F) were analyzed. The median time from the first dose of any treatment to post-medication ECG was 2 days (IQR: 1-3). QTc in men increased from baseline (440 vs 455 ms, p < 0.001), as well as in women (438 vs 463 ms, p < 0.001). The proportion of patients with QT prolongation increased significantly (14.3% vs 34.3%, p < 0.001) even when adjusted for electrolyte abnormalities. The number of patients whose QTc > 500 ms was significantly increased after treatment (16.2% vs. 4.8%, p < 0.01). Patients with either QTc > 500 ms or an increase of 60 ms had a higher frequency of death (47.6% vs. 22.6%, p = 0.02) with an odds ratio of 3.1 (95% CI: 1.1-8.7). Adjusting for race/ethnicity yielded no significant associations. CONCLUSIONS: Hydroxychloroquine, chloroquine, and/or azithromycin were associated with QTc prolongation but did not result in fatal arrhythmias. Our findings suggest that any harm is unlikely to outweigh potential benefits of treatment. Careful risk-benefit analyses for individual patients should guide the use of these medications. Randomized control trials are necessary to evaluate their efficacies.


Subject(s)
Antimalarials/adverse effects , Azithromycin/adverse effects , Coronavirus Infections/drug therapy , Electrocardiography/methods , Long QT Syndrome/chemically induced , Pneumonia, Viral/drug therapy , Age Distribution , Aged , Aged, 80 and over , Antimalarials/administration & dosage , Azithromycin/administration & dosage , COVID-19 , Chloroquine/administration & dosage , Chloroquine/adverse effects , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Incidence , Long QT Syndrome/diagnostic imaging , Long QT Syndrome/drug therapy , Long QT Syndrome/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Risk Assessment , Sex Distribution , Urban Population
9.
J Interv Card Electrophysiol ; 59(2): 329-336, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-505746

ABSTRACT

BACKGROUND: Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey. METHODS: The Heart Rhythm Society (HRS) sent an online survey (via SurveyMonkey) to electrophysiology (EP) professionals (physicians, scientists, and allied professionals) across the globe. The survey was active from March 27 to April 13, 2020. RESULTS: A total of 1197 respondents completed the survey with 50% of respondents from outside the USA, representing 76 countries and 6 continents. Of respondents, 905 (76%) reported having COVID-19-positive patients in their hospital. Atrial fibrillation was the most commonly reported tachyarrhythmia whereas severe sinus bradycardia and complete heart block were the most common bradyarrhythmias. Ventricular tachycardia/ventricular fibrillation arrest and pulseless electrical activity were reported by 4.8% and 5.6% of respondents, respectively. There were 140 of 631 (22.2%) respondents who reported using anticoagulation therapy in all COVID-19-positive patients who did not otherwise have an indication. One hundred fifty-five of 498 (31%) reported regular use of hydroxychloroquine/chloroquine (HCQ) + azithromycin (AZM); concomitant use of AZM was more common in the USA. Sixty of 489 respondents (12.3%) reported having to discontinue therapy with HCQ + AZM due to significant QTc prolongation and 20 (4.1%) reported cases of Torsade de Pointes in patients on HCQ/chloroquine and AZM. Amiodarone was the most common antiarrhythmic drug used for ventricular arrhythmia management. CONCLUSIONS: In this global survey of > 1100 EP professionals regarding hospitalized COVID-19 patients, a variety of arrhythmic manifestations were observed, ranging from benign to potentially life-threatening. Observed adverse events related to use of HCQ + AZM included prolonged QTc requiring drug discontinuation as well as Torsade de Pointes. Large prospective studies to better define arrhythmic manifestations as well as the safety of treatment strategies in COVID-19 patients are warranted.


Subject(s)
Anti-Arrhythmia Agents/administration & dosage , Arrhythmias, Cardiac/diagnostic imaging , Arrhythmias, Cardiac/epidemiology , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , Arrhythmias, Cardiac/drug therapy , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Cross-Sectional Studies , Electrocardiography/methods , Female , Humans , Incidence , Long QT Syndrome/diagnostic imaging , Long QT Syndrome/drug therapy , Long QT Syndrome/epidemiology , Male , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Prognosis , Severity of Illness Index , Survival Rate , Torsades de Pointes/diagnostic imaging , Torsades de Pointes/drug therapy , Torsades de Pointes/epidemiology , Treatment Outcome
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