Prophylactic (hydroxy)chloroquine in COVID-19: Potential relevance for cardiac arrhythmia risk.
Identifieur interne : 000078 ( Main/Corpus ); précédent : 000077; suivant : 000079Prophylactic (hydroxy)chloroquine in COVID-19: Potential relevance for cardiac arrhythmia risk.
Auteurs : Joost A. Offerhaus ; Arthur A M. Wilde ; Carol Ann RemmeSource :
- Heart rhythm [ 1556-3871 ] ; 2020.
Abstract
(Hydroxy)chloroquine ((H)CQ) is being investigated as a treatment of COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to the hospital and hence likely already (severely) affected. Another suggested approach uses prophylactic (H)CQ treatment aimed at preventing either severe acute respiratory syndrome coronavirus 2 infection or the development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ. However, (H)CQ may lead to QT prolongation and potentially induce life-threatening arrhythmias. This may be of particular relevance to patients with preexisting cardiovascular disease and those taking other QT-prolonging drugs. In addition, it is known that a certain percentage of the population carries genetic variant(s) that reduces their repolarization reserve, predisposing them to (H)CQ-induced QT prolongation, and this may be more relevant to female patients who already have a longer QT interval to start with. This review provides an overview of the current evidence on (H)CQ therapy in patients with COVID-19 and discusses different strategies for prophylactic (H)CQ therapy (ie, preinfection, postexposure, and postinfection). In particular, the potential cardiac effects, including QT prolongation and arrhythmias, will be addressed. Based on these insights, recommendations will be presented as to which preventive measures should be taken when giving (H)CQ prophylactically, including electrocardiographic monitoring.
DOI: 10.1016/j.hrthm.2020.07.001
PubMed: 32622993
PubMed Central: PMC7332460
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Wilde</name><affiliation><nlm:affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; https://guardheart.ern-net.eu); European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA).</nlm:affiliation></affiliation></author><author><name sortKey="Remme, Carol Ann" sort="Remme, Carol Ann" uniqKey="Remme C" first="Carol Ann" last="Remme">Carol Ann Remme</name><affiliation><nlm:affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA). Electronic address: c.a.remme@amsterdamumc.nl.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32622993</idno><idno type="pmid">32622993</idno><idno type="doi">10.1016/j.hrthm.2020.07.001</idno><idno type="pmc">PMC7332460</idno><idno type="wicri:Area/Main/Corpus">000078</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000078</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Prophylactic (hydroxy)chloroquine in COVID-19: Potential relevance for cardiac arrhythmia risk.</title><author><name sortKey="Offerhaus, Joost A" sort="Offerhaus, Joost A" uniqKey="Offerhaus J" first="Joost A" last="Offerhaus">Joost A. Offerhaus</name><affiliation><nlm:affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Wilde, Arthur A M" sort="Wilde, Arthur A M" uniqKey="Wilde A" first="Arthur A M" last="Wilde">Arthur A M. Wilde</name><affiliation><nlm:affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; https://guardheart.ern-net.eu); European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA).</nlm:affiliation></affiliation></author><author><name sortKey="Remme, Carol Ann" sort="Remme, Carol Ann" uniqKey="Remme C" first="Carol Ann" last="Remme">Carol Ann Remme</name><affiliation><nlm:affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA). Electronic address: c.a.remme@amsterdamumc.nl.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Heart rhythm</title><idno type="eISSN">1556-3871</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">(Hydroxy)chloroquine ((H)CQ) is being investigated as a treatment of COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to the hospital and hence likely already (severely) affected. Another suggested approach uses prophylactic (H)CQ treatment aimed at preventing either severe acute respiratory syndrome coronavirus 2 infection or the development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ. However, (H)CQ may lead to QT prolongation and potentially induce life-threatening arrhythmias. This may be of particular relevance to patients with preexisting cardiovascular disease and those taking other QT-prolonging drugs. In addition, it is known that a certain percentage of the population carries genetic variant(s) that reduces their repolarization reserve, predisposing them to (H)CQ-induced QT prolongation, and this may be more relevant to female patients who already have a longer QT interval to start with. This review provides an overview of the current evidence on (H)CQ therapy in patients with COVID-19 and discusses different strategies for prophylactic (H)CQ therapy (ie, preinfection, postexposure, and postinfection). In particular, the potential cardiac effects, including QT prolongation and arrhythmias, will be addressed. Based on these insights, recommendations will be presented as to which preventive measures should be taken when giving (H)CQ prophylactically, including electrocardiographic monitoring.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32622993</PMID><DateRevised><Year>2020</Year><Month>07</Month><Day>26</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1556-3871</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Jul</Month><Day>03</Day></PubDate></JournalIssue><Title>Heart rhythm</Title><ISOAbbreviation>Heart Rhythm</ISOAbbreviation></Journal><ArticleTitle>Prophylactic (hydroxy)chloroquine in COVID-19: Potential relevance for cardiac arrhythmia risk.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">S1547-5271(20)30634-2</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.hrthm.2020.07.001</ELocationID><Abstract><AbstractText>(Hydroxy)chloroquine ((H)CQ) is being investigated as a treatment of COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to the hospital and hence likely already (severely) affected. Another suggested approach uses prophylactic (H)CQ treatment aimed at preventing either severe acute respiratory syndrome coronavirus 2 infection or the development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ. However, (H)CQ may lead to QT prolongation and potentially induce life-threatening arrhythmias. This may be of particular relevance to patients with preexisting cardiovascular disease and those taking other QT-prolonging drugs. In addition, it is known that a certain percentage of the population carries genetic variant(s) that reduces their repolarization reserve, predisposing them to (H)CQ-induced QT prolongation, and this may be more relevant to female patients who already have a longer QT interval to start with. This review provides an overview of the current evidence on (H)CQ therapy in patients with COVID-19 and discusses different strategies for prophylactic (H)CQ therapy (ie, preinfection, postexposure, and postinfection). In particular, the potential cardiac effects, including QT prolongation and arrhythmias, will be addressed. Based on these insights, recommendations will be presented as to which preventive measures should be taken when giving (H)CQ prophylactically, including electrocardiographic monitoring.</AbstractText><CopyrightInformation>Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Offerhaus</LastName><ForeName>Joost A</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wilde</LastName><ForeName>Arthur A M</ForeName><Initials>AAM</Initials><AffiliationInfo><Affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; https://guardheart.ern-net.eu); European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Remme</LastName><ForeName>Carol Ann</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; European Cardiac Arrhythmia Genetics Focus Group (ECGen) of the European Heart Rhythm Association (EHRA). 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