Research Letter
May 1, 2020

Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit

Francis Bessière, MD, PhD1,2Hugo Roccia, MD3Antoine Delinière, MD1,2et alRome Charrière, MD4Philippe Chevalier, MD, PhD1,2Laurent Argaud, MD, PhD3Martin Cour, MD, PhD2
  • 1Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Service d’électrophysiologie et de Stimulation Cardiaque, Université de Lyon, Lyon, France
  • 2Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Centre de Référence National des Troubles du Rythme Cardiaque d’origine Héréditaire, Lyon, France
  • 3Hospices Civils de Lyon, Hôpital Edouard Herriot, Médecine Intensive – Réanimation, Lyon, France
  • 4Centre Hospitalier de Valence, Service de Maladies Infectieuses, Valence, France
JAMA Cardiol. Published online May 1, 2020. doi:10.1001/jamacardio.2020.1787

The novel coronavirus disease 2019 (COVID-19) outbreak is an ongoing situation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Studies in patients with mild to moderate COVID-19 symptoms have suggested benefits of hydroxychloroquine alone or in combination with azithromycin against SARS-CoV-2 and raised hope for treating the disease.2 As a result, these treatments are increasingly used off-label for patients with COVID-19, including for those in intensive care units (ICUs).2,3 However, both medications are known to induce QT prolongation via a human Ether-à-go-go–related gene potassium channel blockade, which can promote life-threatening ventricular arrhythmias.4,5 Safety data for these treatments are largely lacking for patients with COVID-19. This is even more relevant for critically ill patients who are particularly exposed to electrolyte imbalance and/or drugs leading to an increased risk of QT prolongation.6 Therefore, we aimed to examine the safety of hydroxychloroquine with or without azithromycin regarding QT interval in ICU patients with COVID-19.