Effect of triple combination therapy with lopinavir-ritonavir,
azithromycin and hydroxychloroquine on QT interval and arrhythmic risk
in hospitalized COVID-19 patients.
Abstract
Introduction: no data are provided about the effect of triple
combination therapy with Lopinavir/Ritonavir (LPN/RTN),
hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc)
interval and arrhythmic risk, in COVID-19 patients. This study aims to
describe the incidence of extreme QTc interval prolongation among
COVID-19 patients on this experimental treatment and to identify the
clinical features associated with extreme QTc prolongation. Materials
and methods: data of 87 COVID-19 patients, treated with triple
combination including LPN/RTN, HQ and AZT, were analyzed. QT interval
was obtained by the tangent method and corrected for heart rate using
Bazett’s formula. Extreme QTc interval prolongation was considered an
absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60
milliseconds or greater (ΔQTc ≥ 60 milliseconds) compared with baseline.
Results: Hypertension (66.7%) and diabetes (25.3%) were the most
prevalent cardiovascular comorbidities. 20 patients (23%) showed
extreme QTc interval prolongation; No clinical, electrocardiographic or
pharmacological characteristics have been associated to extreme QTc
prolongation, except the history of ischemic stroke (P= 0,007). One
torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc:
560 ms) after 5 days of therapy was recorded. Conclusions: We observed a
high incidence of extreme QTc interval prolongation among COVID-19
patients on triple combination therapy. The incidence of malignant
arrhythmias seems to be low, a careful electrocardiographic monitoring
would be advisable.