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, PhD1,2; Hugo Roccia, MD3; Antoine Delinière, MD1,2; et alRome Charrière, MD4; Philippe Chevalier, MD, PhD1,2; Laurent Argaud, MD, PhD3; Martin 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.