Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.

During the COVID-19 pandemic, the effectiveness of the combination of hydroxychloroquine and azithromycin is widely discussed. This treatment can cause many severe cardiac side effects that makes us discuss its utility. The aim of this study is to describe the cardiovascular effect of hydroxychloroquine and azithromycin by analyzing surface ECG in patients with COVID-19. This observational cohort study included Moroccan patients with COVID-19 diagnosis and were hospitalized in Cheikh Khalifa International University Hospital, Casablanca, Morocco between March 26 and April 20, 2020. Patients were treated with a combination of hydroxychloroquine and azithromycin over a period of at least ten days. We were interested in the effects of this combination on the electrocardiogram. A total of 118 eligible patients were enrolled in the study. QT interval prolongation was observed in 19% of patients under the treatment. Only 5 patients required discontinuation of treatment. The factors associated with QT prolongation are male gender (P value 0,043), age over 68 years (P value 0,09), cardiovascular comorbidity (P value 0,013), tisdale score ≥11 (P value < 0,001), and a severe form of COVID-19 (P value < 0,001). First degree atrioventricular block was observed in 2 patients. No serious rhythm or conduction disorders were observed in this study. QT prolongation is a real risk with the combination of hydroxychloroquine and azithromycin. In the current context, it is necessary to select patients at high risk of severe rhythm disturbances that require closer ECG monitoring. Treatment should be discontinued if there are alarming signs such as QTc prolongation beyond 550 ms and the development of ventricular extrasystole or torsade de pointe.

Pacemakers implantation and radiofrequency catheter ablation procedures during medical missions in Morocco: an 8-year experience.

AIMS: Radiofrequency catheter ablation (RFCA) for arrhythmias in the context of short-term medical missions (MM) in a developing country has not been reported so far. We describe here our experience with RFCA and pacemaker implantation in Morocco with a fully portable electrophysiological (EP) system under the auspice of the Monaco-Morocco Cardiology Association. METHODS AND RESULTS: Since November 2007, two to three MM (mean duration 4 days including transportation) per year were conducted (including two physicians and one nurse from Monaco) and were alternately located in Marrakech, Fes, Agadir, Casablanca, Rabat, Essaouira, and Oujda. All patients' files were sent by local teams and/or referring Moroccan cardiologists before MM. Each case was discussed with the Monaco EP team before the MM. Pacemakers and leads were donated by companies (Sorin Group, Medtronic, Saint-Jude Medical). The EP system (EP Tracer, CardioTek) as well as diagnostic/ablation catheters were brought for RFCA procedures. After the procedures, follow-up was performed by local teams. Procedures took place in gynaecological or orthopaedic operating room, or, when available, in the interventional cardiology cathlab. Thirty-one RFCA were performed during 11 MM (atrioventricular node re-entrant tachycardia = 12; atrioventricular re-entrant tachycardia/Mahaïm fibre = 15; typical atrial flutter = 3; ventricular ectopy = 1). Acute success was 93.5% for RFCA. Two major RFCA-related complications occurred (air embolism and complete atrioventricular block). No complication was related to pacemaker implantations (n = 44; mean 4 pacemakers per mission). CONCLUSION: Radiofrequency catheter ablation for arrhythmias in developing countries is technically challenging but feasible, despite technical and cultural difficulties.

Management of acute coronary syndromes in Maghreb countries: The ACCESS (ACute Coronary Events - a multinational Survey of current management Strategies) registry.

BACKGROUND: The burden of cardiovascular diseases is anticipated to rise in developing countries. We sought to describe the epidemiology, management, and clinical outcomes of patients hospitalized with acute coronary syndromes (ACS) in three countries in western North Africa. METHODS: Adult patients hospitalized with a diagnosis of ACS were enrolled in the prospective ACute Coronary Events - a multinational Survey of current management Strategies (ACCESS) registry over a 13-month period (January 2007 to January 2008). We report on patients enrolled at sites in Algeria, Morocco and Tunisia. A standardized form was used to collect data on patient characteristics, treatments and outcomes. RESULTS: A total of 1687 patients with confirmed ACS were enrolled (median age 59 [interquartile range 52, 68] years; 76% men), 59% with ST-elevation myocardial infarction (STEMI) and 41% with non-ST-elevation ACS (NSTE-ACS). During hospitalization, most patients received aspirin (96%) and a statin (90%), 83% received a beta-blocker and 74% an angiotensin-converting enzyme inhibitor. Among eligible STEMI patients, 42% (419/989) did not receive fibrinolysis or undergo percutaneous coronary intervention. All-cause death at 12 months was 8.1% and did not differ significantly between patients with STEMI or NSTE-ACS (8.3% vs 7.7%, respectively; Log-rank test P=0.82). Clinical factors associated with higher risk of death at 12 months included cardiac arrest, cardiogenic shock, bleeding episodes and diabetes, while percutaneous coronary intervention and male sex were associated with lower risk. CONCLUSIONS: In this observational study of ACS patients from three Maghreb countries, the use of evidence-based pharmacological therapies for ACS was quite high; however, 42% of the patients with STEMI were not given any form of reperfusion therapy.

[Myocardial infarction in patients with diabetes: comparative series of 85 patients with 16 patients without diabetes]. / Infarctus du myocarde chez le diabétique: présentation d'une série de 85 patients diabétiques comparée à 106 patients non diabétiques.

OBJECTIVES: The aim of this study was to determine the clinical characteristics, treatment and development of myocardial infarction in patients with diabetes. METHODS: From September 1999 through December 2003, 191 patients with myocardial infarction were hospitalized in the cardiology department of the Mohamed V military teaching hospital in Rabat, Morocco. They included 85 patients with diabetes (D) and 106 without it (ND). RESULTS: Comparison of these two groups showed a higher percentage of women among the patients with diabetes. Hypertension was more frequent in patients with diabetes, while smoking was frequent in both groups. The clinical picture was similar in both groups, as was the frequency of left ventricular dysfunction, determined by transthoracic echocardiography. Coronary angiography showed damage in three arteries was more common in the D group, while single-artery damage was more frequent in the ND group. Treatment was similar in both groups. In all, 49 patients underwent myocardial revascularization, and its method (angioplasty or aortic surgery) did not differ by group. Neither hospital mortality nor other complications differed between the two groups, with a follow-up of 3.98 +/- 1.99 years for ND patients and 2.68 +/- 1.32 years for D patients. CONCLUSION: Correct management of myocardial infarction and its cardiovascular risk factors, development of means of revascularization, and close collaboration between cardiologists and endocrinologists should improve prognosis for patients with diabetes who have myocardial infarctions.