Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.
Identifieur interne : 001233 ( Main/Exploration ); précédent : 001232; suivant : 001234Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.
Auteurs : Amal El Ouarradi [Maroc] ; Salma Abdeladim [Maroc] ; Sara Oualim [Maroc] ; Rita Aniq Filali [Maroc] ; Ilham Bensahi [Maroc] ; Mahassine Elharass [Maroc] ; Sara Hafid [Maroc] ; Hamza Tazi [Maroc] ; Abdelhamid Naitlhou [Maroc] ; El Arbi Bouaiti [Maroc] ; Abdelhamid Moustaghfir [Maroc] ; Mohamed Sabry [Maroc]Source :
- Journal of the Saudi Heart Association [ 1016-7315 ] ; 2020.
Abstract
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.
DOI: 10.37616/2212-5043.1088
PubMed: 33299775
PubMed Central: PMC7721450
Affiliations:
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Ouarradi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Abdeladim, Salma" sort="Abdeladim, Salma" uniqKey="Abdeladim S" first="Salma" last="Abdeladim">Salma Abdeladim</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Oualim, Sara" sort="Oualim, Sara" uniqKey="Oualim S" first="Sara" last="Oualim">Sara Oualim</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Filali, Rita Aniq" sort="Filali, Rita Aniq" uniqKey="Filali R" first="Rita Aniq" last="Filali">Rita Aniq Filali</name><affiliation wicri:level="1"><nlm:affiliation>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Bensahi, Ilham" sort="Bensahi, Ilham" uniqKey="Bensahi I" first="Ilham" last="Bensahi">Ilham Bensahi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Elharass, Mahassine" sort="Elharass, Mahassine" uniqKey="Elharass M" first="Mahassine" last="Elharass">Mahassine Elharass</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Hafid, Sara" sort="Hafid, Sara" uniqKey="Hafid S" first="Sara" last="Hafid">Sara Hafid</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Tazi, Hamza" sort="Tazi, Hamza" uniqKey="Tazi H" first="Hamza" last="Tazi">Hamza Tazi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Naitlhou, Abdelhamid" sort="Naitlhou, Abdelhamid" uniqKey="Naitlhou A" first="Abdelhamid" last="Naitlhou">Abdelhamid Naitlhou</name><affiliation wicri:level="1"><nlm:affiliation>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Bouaiti, El Arbi" sort="Bouaiti, El Arbi" uniqKey="Bouaiti E" first="El Arbi" last="Bouaiti">El Arbi Bouaiti</name><affiliation wicri:level="1"><nlm:affiliation>Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat</wicri:regionArea><wicri:noRegion>Mohammed V University in Rabat</wicri:noRegion></affiliation></author><author><name sortKey="Moustaghfir, Abdelhamid" sort="Moustaghfir, Abdelhamid" uniqKey="Moustaghfir A" first="Abdelhamid" last="Moustaghfir">Abdelhamid Moustaghfir</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author><author><name sortKey="Sabry, Mohamed" sort="Sabry, Mohamed" uniqKey="Sabry M" first="Mohamed" last="Sabry">Mohamed Sabry</name><affiliation wicri:level="1"><nlm:affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</nlm:affiliation><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca</wicri:regionArea><wicri:noRegion>Casablanca</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of the Saudi Heart Association</title><idno type="ISSN">1016-7315</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">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.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33299775</PMID><DateRevised><Year>2020</Year><Month>12</Month><Day>11</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Print">1016-7315</ISSN><JournalIssue CitedMedium="Print"><Volume>32</Volume><Issue>3</Issue><PubDate><Year>2020</Year></PubDate></JournalIssue><Title>Journal of the Saudi Heart Association</Title><ISOAbbreviation>J Saudi Heart Assoc</ISOAbbreviation></Journal><ArticleTitle>Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.</ArticleTitle><Pagination><MedlinePgn>350-357</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.37616/2212-5043.1088</ELocationID><Abstract><AbstractText>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.</AbstractText><CopyrightInformation>© 2020 Saudi Heart Association.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>El Ouarradi</LastName><ForeName>Amal</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Abdeladim</LastName><ForeName>Salma</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Oualim</LastName><ForeName>Sara</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Filali</LastName><ForeName>Rita Aniq</ForeName><Initials>RA</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bensahi</LastName><ForeName>Ilham</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Elharass</LastName><ForeName>Mahassine</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hafid</LastName><ForeName>Sara</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tazi</LastName><ForeName>Hamza</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Naitlhou</LastName><ForeName>Abdelhamid</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bouaiti</LastName><ForeName>El Arbi</ForeName><Initials>EA</Initials><AffiliationInfo><Affiliation>Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Moustaghfir</LastName><ForeName>Abdelhamid</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sabry</LastName><ForeName>Mohamed</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Mohammed VI University of Health Sciences, Cheikh Khalifa Hospital, Casablanca, Morocco.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>Saudi Arabia</Country><MedlineTA>J Saudi Heart Assoc</MedlineTA><NlmUniqueID>9887261</NlmUniqueID><ISSNLinking>1016-7315</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Azithromycin</Keyword><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Electrocardiogram</Keyword><Keyword MajorTopicYN="N">Hydroxychloroquine</Keyword><Keyword MajorTopicYN="N">QT prolongation</Keyword></KeywordList><CoiStatement>All authors declare no competing interests.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>06</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>06</Month><Day>29</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>12</Month><Day>10</Day><Hour>5</Hour><Minute>58</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>12</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>12</Month><Day>11</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33299775</ArticleId><ArticleId IdType="doi">10.37616/2212-5043.1088</ArticleId><ArticleId IdType="pii">sha-32-03-350</ArticleId><ArticleId IdType="pmc">PMC7721450</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Drug Saf. 2018 Oct;41(10):919-931</Citation><ArticleIdList><ArticleId IdType="pubmed">29858838</ArticleId></ArticleIdList></Reference><Reference><Citation>Mayo Clin Proc. 2020 Jun;95(6):1213-1221</Citation><ArticleIdList><ArticleId 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uniqKey="Naitlhou A" first="Abdelhamid" last="Naitlhou">Abdelhamid Naitlhou</name><name sortKey="Oualim, Sara" sort="Oualim, Sara" uniqKey="Oualim S" first="Sara" last="Oualim">Sara Oualim</name><name sortKey="Sabry, Mohamed" sort="Sabry, Mohamed" uniqKey="Sabry M" first="Mohamed" last="Sabry">Mohamed Sabry</name><name sortKey="Tazi, Hamza" sort="Tazi, Hamza" uniqKey="Tazi H" first="Hamza" last="Tazi">Hamza Tazi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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