Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.
Identifieur interne : 001854 ( Main/Corpus ); précédent : 001853; suivant : 001855Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.
Auteurs : Moussa Saleh ; James Gabriels ; David Chang ; Beom Soo Kim ; Amtul Mansoor ; Eitezaz Mahmood ; Parth Makker ; Haisam Ismail ; Bruce Goldner ; Jonathan Willner ; Stuart Beldner ; Raman Mitra ; Roy John ; Jason Chinitz ; Nicholas Skipitaris ; Stavros Mountantonakis ; Laurence M. EpsteinSource :
- Circulation. Arrhythmia and electrophysiology [ 1941-3084 ] ; 2020.
English descriptors
- KwdEn :
- Anti-Bacterial Agents (adverse effects), Anti-Bacterial Agents (therapeutic use), Antimalarials (adverse effects), Antimalarials (therapeutic use), Arrhythmias, Cardiac (chemically induced), Arrhythmias, Cardiac (complications), Arrhythmias, Cardiac (epidemiology), Azithromycin (adverse effects), Azithromycin (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Chloroquine (adverse effects), Chloroquine (therapeutic use), Coronavirus Infections (drug therapy), Coronavirus Infections (epidemiology), Coronavirus Infections (physiopathology), Drug Therapy, Combination (MeSH), Electrocardiography (drug effects), Follow-Up Studies (MeSH), Humans (MeSH), Hydroxychloroquine (adverse effects), Hydroxychloroquine (therapeutic use), Incidence (MeSH), Pandemics (MeSH), Pneumonia, Viral (drug therapy), Pneumonia, Viral (epidemiology), Pneumonia, Viral (physiopathology), Prospective Studies (MeSH), Risk Factors (MeSH), SARS-CoV-2 (MeSH), United States (epidemiology).
- MESH :
- chemical , adverse effects : Anti-Bacterial Agents, Antimalarials, Azithromycin, Chloroquine, Hydroxychloroquine.
- chemical , therapeutic use : Anti-Bacterial Agents, Antimalarials, Azithromycin, Chloroquine, Hydroxychloroquine.
- geographic , epidemiology : United States.
- chemically induced : Arrhythmias, Cardiac.
- complications : Arrhythmias, Cardiac.
- drug effects : Electrocardiography.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Arrhythmias, Cardiac, Coronavirus Infections, Pneumonia, Viral.
- physiopathology : Coronavirus Infections, Pneumonia, Viral.
- Betacoronavirus, COVID-19, Drug Therapy, Combination, Follow-Up Studies, Humans, Incidence, Pandemics, Prospective Studies, Risk Factors, SARS-CoV-2.
Abstract
BACKGROUND
The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death.
METHODS
Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death.
RESULTS
Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms,
CONCLUSIONS
In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.
DOI: 10.1161/CIRCEP.120.008662
PubMed: 32347743
PubMed Central: PMC7299095
Links to Exploration step
pubmed:32347743Le document en format XML
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Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Chang, David" sort="Chang, David" uniqKey="Chang D" first="David" last="Chang">David Chang</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Soo Kim, Beom" sort="Soo Kim, Beom" uniqKey="Soo Kim B" first="Beom" last="Soo Kim">Beom Soo Kim</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mansoor, Amtul" sort="Mansoor, Amtul" uniqKey="Mansoor A" first="Amtul" last="Mansoor">Amtul Mansoor</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mahmood, Eitezaz" sort="Mahmood, Eitezaz" uniqKey="Mahmood E" first="Eitezaz" last="Mahmood">Eitezaz Mahmood</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Makker, Parth" sort="Makker, Parth" uniqKey="Makker P" first="Parth" last="Makker">Parth Makker</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Ismail, Haisam" sort="Ismail, Haisam" uniqKey="Ismail H" first="Haisam" last="Ismail">Haisam Ismail</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</nlm:affiliation></affiliation></author><author><name sortKey="Goldner, Bruce" sort="Goldner, Bruce" uniqKey="Goldner B" first="Bruce" last="Goldner">Bruce Goldner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</nlm:affiliation></affiliation></author><author><name sortKey="Willner, Jonathan" sort="Willner, Jonathan" uniqKey="Willner J" first="Jonathan" last="Willner">Jonathan Willner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Beldner, Stuart" sort="Beldner, Stuart" uniqKey="Beldner S" first="Stuart" last="Beldner">Stuart Beldner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mitra, Raman" sort="Mitra, Raman" uniqKey="Mitra R" first="Raman" last="Mitra">Raman Mitra</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="John, Roy" sort="John, Roy" uniqKey="John R" first="Roy" last="John">Roy John</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Chinitz, Jason" sort="Chinitz, Jason" uniqKey="Chinitz J" first="Jason" last="Chinitz">Jason Chinitz</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Southside Hospital, Northwell Health, Bay Shore (J.C.).</nlm:affiliation></affiliation></author><author><name sortKey="Skipitaris, Nicholas" sort="Skipitaris, Nicholas" uniqKey="Skipitaris N" first="Nicholas" last="Skipitaris">Nicholas Skipitaris</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Mountantonakis, Stavros" sort="Mountantonakis, Stavros" uniqKey="Mountantonakis S" first="Stavros" last="Mountantonakis">Stavros Mountantonakis</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Epstein, Laurence M" sort="Epstein, Laurence M" uniqKey="Epstein L" first="Laurence M" last="Epstein">Laurence M. Epstein</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32347743</idno><idno type="pmid">32347743</idno><idno type="doi">10.1161/CIRCEP.120.008662</idno><idno type="pmc">PMC7299095</idno><idno type="wicri:Area/Main/Corpus">001854</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001854</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.</title><author><name sortKey="Saleh, Moussa" sort="Saleh, Moussa" uniqKey="Saleh M" first="Moussa" last="Saleh">Moussa Saleh</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Gabriels, James" sort="Gabriels, James" uniqKey="Gabriels J" first="James" last="Gabriels">James Gabriels</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Chang, David" sort="Chang, David" uniqKey="Chang D" first="David" last="Chang">David Chang</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Soo Kim, Beom" sort="Soo Kim, Beom" uniqKey="Soo Kim B" first="Beom" last="Soo Kim">Beom Soo Kim</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mansoor, Amtul" sort="Mansoor, Amtul" uniqKey="Mansoor A" first="Amtul" last="Mansoor">Amtul Mansoor</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mahmood, Eitezaz" sort="Mahmood, Eitezaz" uniqKey="Mahmood E" first="Eitezaz" last="Mahmood">Eitezaz Mahmood</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Makker, Parth" sort="Makker, Parth" uniqKey="Makker P" first="Parth" last="Makker">Parth Makker</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Ismail, Haisam" sort="Ismail, Haisam" uniqKey="Ismail H" first="Haisam" last="Ismail">Haisam Ismail</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</nlm:affiliation></affiliation></author><author><name sortKey="Goldner, Bruce" sort="Goldner, Bruce" uniqKey="Goldner B" first="Bruce" last="Goldner">Bruce Goldner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</nlm:affiliation></affiliation></author><author><name sortKey="Willner, Jonathan" sort="Willner, Jonathan" uniqKey="Willner J" first="Jonathan" last="Willner">Jonathan Willner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Beldner, Stuart" sort="Beldner, Stuart" uniqKey="Beldner S" first="Stuart" last="Beldner">Stuart Beldner</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Mitra, Raman" sort="Mitra, Raman" uniqKey="Mitra R" first="Raman" last="Mitra">Raman Mitra</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="John, Roy" sort="John, Roy" uniqKey="John R" first="Roy" last="John">Roy John</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author><author><name sortKey="Chinitz, Jason" sort="Chinitz, Jason" uniqKey="Chinitz J" first="Jason" last="Chinitz">Jason Chinitz</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Southside Hospital, Northwell Health, Bay Shore (J.C.).</nlm:affiliation></affiliation></author><author><name sortKey="Skipitaris, Nicholas" sort="Skipitaris, Nicholas" uniqKey="Skipitaris N" first="Nicholas" last="Skipitaris">Nicholas Skipitaris</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Mountantonakis, Stavros" sort="Mountantonakis, Stavros" uniqKey="Mountantonakis S" first="Stavros" last="Mountantonakis">Stavros Mountantonakis</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</nlm:affiliation></affiliation></author><author><name sortKey="Epstein, Laurence M" sort="Epstein, Laurence M" uniqKey="Epstein L" first="Laurence M" last="Epstein">Laurence M. Epstein</name><affiliation><nlm:affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</nlm:affiliation></affiliation></author></analytic><series><title level="j">Circulation. Arrhythmia and electrophysiology</title><idno type="eISSN">1941-3084</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anti-Bacterial Agents (adverse effects)</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Antimalarials (adverse effects)</term><term>Antimalarials (therapeutic use)</term><term>Arrhythmias, Cardiac (chemically induced)</term><term>Arrhythmias, Cardiac (complications)</term><term>Arrhythmias, Cardiac (epidemiology)</term><term>Azithromycin (adverse effects)</term><term>Azithromycin (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Chloroquine (adverse effects)</term><term>Chloroquine (therapeutic use)</term><term>Coronavirus Infections (drug therapy)</term><term>Coronavirus Infections (epidemiology)</term><term>Coronavirus Infections (physiopathology)</term><term>Drug Therapy, Combination (MeSH)</term><term>Electrocardiography (drug effects)</term><term>Follow-Up Studies (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (adverse effects)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Incidence (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (drug therapy)</term><term>Pneumonia, Viral (epidemiology)</term><term>Pneumonia, Viral (physiopathology)</term><term>Prospective Studies (MeSH)</term><term>Risk Factors (MeSH)</term><term>SARS-CoV-2 (MeSH)</term><term>United States (epidemiology)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Antimalarials</term><term>Azithromycin</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Antimalarials</term><term>Azithromycin</term><term>Chloroquine</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Arrhythmias, Cardiac</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Arrhythmias, Cardiac</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Electrocardiography</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Arrhythmias, Cardiac</term><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term><term>COVID-19</term><term>Drug Therapy, Combination</term><term>Follow-Up Studies</term><term>Humans</term><term>Incidence</term><term>Pandemics</term><term>Prospective Studies</term><term>Risk Factors</term><term>SARS-CoV-2</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, </p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32347743</PMID><DateCompleted><Year>2020</Year><Month>07</Month><Day>02</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>18</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1941-3084</ISSN><JournalIssue CitedMedium="Internet"><Volume>13</Volume><Issue>6</Issue><PubDate><Year>2020</Year><Month>06</Month></PubDate></JournalIssue><Title>Circulation. Arrhythmia and electrophysiology</Title><ISOAbbreviation>Circ Arrhythm Electrophysiol</ISOAbbreviation></Journal><ArticleTitle>Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.</ArticleTitle><Pagination><MedlinePgn>e008662</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1161/CIRCEP.120.008662</ELocationID><Abstract><AbstractText Label="BACKGROUND">The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death.</AbstractText><AbstractText Label="METHODS">Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death.</AbstractText><AbstractText Label="RESULTS">Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, <i>P</i>=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4±45.0 ms versus 453.3±37.0 ms, <i>P</i>=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported.</AbstractText><AbstractText Label="CONCLUSIONS">In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Saleh</LastName><ForeName>Moussa</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gabriels</LastName><ForeName>James</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chang</LastName><ForeName>David</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Soo Kim</LastName><ForeName>Beom</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mansoor</LastName><ForeName>Amtul</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mahmood</LastName><ForeName>Eitezaz</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Makker</LastName><ForeName>Parth</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ismail</LastName><ForeName>Haisam</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Goldner</LastName><ForeName>Bruce</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Willner</LastName><ForeName>Jonathan</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Beldner</LastName><ForeName>Stuart</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mitra</LastName><ForeName>Raman</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>John</LastName><ForeName>Roy</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chinitz</LastName><ForeName>Jason</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Southside Hospital, Northwell Health, Bay Shore (J.C.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Skipitaris</LastName><ForeName>Nicholas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mountantonakis</LastName><ForeName>Stavros</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Epstein</LastName><ForeName>Laurence M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.).</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>04</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Circ Arrhythm Electrophysiol</MedlineTA><NlmUniqueID>101474365</NlmUniqueID><ISSNLinking>1941-3084</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000900">Anti-Bacterial Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000962">Antimalarials</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical><Chemical><RegistryNumber>886U3H6UFF</RegistryNumber><NameOfSubstance UI="D002738">Chloroquine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000900" MajorTopicYN="N">Anti-Bacterial Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000962" MajorTopicYN="N">Antimalarials</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="Y">chemically induced</QualifierName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017963" MajorTopicYN="N">Azithromycin</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002738" MajorTopicYN="N">Chloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">QT prolongation</Keyword><Keyword MajorTopicYN="Y">azithromycin</Keyword><Keyword MajorTopicYN="Y">chloroquine</Keyword><Keyword MajorTopicYN="Y">hydroxychloroquine</Keyword><Keyword MajorTopicYN="Y">pandemic</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate 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