Effects of treatment with hydroxychloroquine and azithromycin on the index of cardiac electrophysiological balance in patients with COVID-19: A retrospective cohort study

Year 2021, Volume: 5 Issue: 5, 412 - 416, 01.05.2021

Songül Araç , Mehmet Zülkif Karahan , Mehmet Özel , Ramazan Yiğit , Hasan Akkoç , Eşref Araç

https://doi.org/10.28982/josam.843042

Abstract

Background/Aim: The common cardiac toxicities of hydroxychloroquine (HCQ) and azithromycin (AZ) are not well defined in COVID-19 patients. Index of cardiac electrophysiological balance (iCEB) is used as a novel risk marker for drug-induced arrhythmias. The purpose of this study was to evaluate ventricular repolarization using iCEB and other conventional ECG parameters such as the end of electrocardiographic T wave (Tp-e) interval, Tp-e/QT ratio, and Tp-e/ heart rate-corrected QT (QTc) ratio in COVID-19 patients treated with HCQ and AZ.
Methods: This retrospective study enrolled 164 patients diagnosed with COVID-19 pneumonia in the Emergency Department (ED) and then transferred to the ward or the intensive care unit in April 2020.
Results: A total of 164 patients with a mean age of 47 (18) years (range: 18-97 years) included 83 (50.6%) females. There were 38 and 126 patients in Groups HTQ and HTQ+AZ, respectively. On the 5th day of hospitalization, all patients’ heart rates were significantly lower (P<0.001), while QTc, QT max (V5-V6), QTmin, Tp-e (V5-V6), and iCEB values were significantly higher (P=0.01 and P<0.001 for the rest, respectively) compared to the basal values measured in the ED (P<0.001). iCEB values of the HTZ+AZ group were significantly higher than those of the HTQ group (P=0.03). iCEBc strongly positively correlated with Tp-e/QT (V5), and strongly negatively correlated with Tp-e (V5).
Conclusion: The iCEB values were increased after HTQ and AZ treatment among COVID-19 patients, and strongly correlated with Tp-e and Tp-e/QT. iCEB is a simple, non-invasive method that can be a useful marker to evaluate ventricular repolarization in COVID-19 patients.

Keywords

COVID-19, Hydroxychloroquine, Azithromycin, ECG, iCEB, Tp-e interval

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