scholarly journals Impact of Hydroxychloroquine Treatment of COVID-19 on Cardiac Conduction: The Beat Goes On

COVID ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 458-464
Author(s):  
Marc Thomas Zughaib ◽  
Robby Singh ◽  
Marcel Letourneau ◽  
Marcel Elias Zughaib
Keyword(s):  
Average Length ◽  
Torsades De Pointes ◽  
The United States ◽  
Qt Prolongation ◽  
Cardiac Conduction ◽  
Drug Induced ◽  
Average Length Of Stay ◽  
Qt Intervals ◽  
Increased Risk ◽  
Medical Histories

Objectives: Our study aimed to investigate the frequency of malignant cardiac arrhythmias in hospitalized patients receiving hydroxychloroquine alone and those receiving a combination of hydroxychloroquine with azithromycin, as well as the quantitative extent of QT prolongation within Tisdale Risk Score (TRS) categories. Background: There have been over 33 million cases of SARS-CoV-2 (COVID-19) resulting in over 600,000 deaths in the United States. As the current COVID-19 pandemic continues, numerous medications have been administered to attempt to treat patients afflicted by the disease. While hydroxychloroquine has been in use for decades for rheumatologic and infectious disease processes, it does have potential cardiotoxicity related to drug-induced QT prolongation. Drug-induced QT prolongation has an increased risk of arrhythmogenicity, potentially progressing into torsades de pointes (TdP) and increased patient mortality. The relationship between QT prolongation and TdP is complex and inexact, but there remains optimism regarding the use of these medications in the treatment of COVID-19 despite limited data on their true efficacy. Methods: We retrospectively identified 75 patients who were admitted with COVID-19 and underwent treatment with hydroxychloroquine for 5 days. The hydroxychloroquine protocol was defined as an initial dose of 400 mg BID for the first day, followed by 400 mg daily for the next 4 days. Baseline demographics, medications, medical histories, lab values, ECG QT intervals, and Tisdale Risk Categories were collected for all patients. Results: Seventy-four (98.7%) patients completed the full course of hydroxychloroquine. There were 41 males (54.7%) and 34 females (45.3%). Average length of stay was 8.9 days (95% CI: 7.5, 10.2). One patient who could not complete the course due to inability to swallow medication tablets. There were no reports of new arrythmias or incidence of torsades de pointes during the study. Seventy-two patients (96%) were taking at least 2 QT prolonging medications. The average corrected QT intervals were as follows: day 1 of admission was 421.62 milliseconds (n = 66, 95% CI: 412.19, 431.05), day 2 was 431.50 ms (n = 30, 95% CI: 416.34, 446.66), day 3 was 433.48 ms (n = 23, 95% CI: 413.34, 453.61), day 4 was 427.59 ms (n = 17, 95% CI: 400.83, 454.35), and day 5 was 444.28 ms (n = 18, 95% CI: 428.43, 460.12). The corrected QT interval prolonged by 22.66 ms from day 1 to day 5 (p = 0.03) in the overall population. Conclusion: There were no patients who experienced arrhythmogenicity or Torsades de Pointes despite a statistically significant increase in QTc intervals after patients received the 5-day course of hydroxychloroquine for treatment of COVID-19.

scholarly journals Torsades de Pointes after Ondansetron Infusion in 2 Patients

2017 ◽  
Vol 44 (5) ◽  
pp. 366-369 ◽  
Author(s):  
Danny Y. Lee ◽  
Tri Trinh ◽  
Sion K. Roy
Keyword(s):  
Risk Factors ◽  
Receptor Antagonist ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Torsades De Pointes ◽  
Qt Prolongation ◽  
Drug Induced ◽  
Qt Intervals ◽  
Type 3

Drugs that prolong the electrocardiographic QT interval increase the risk of ventricular arrhythmias, particularly torsades de pointes. Ondansetron, a 5-hydroxytryptamine type 3 receptor antagonist antiemetic, is one such drug. We present the cases of 2 patients who were given intravenous ondansetron and subsequently developed torsades de pointes. Both had normal QT intervals at baseline but were discovered to have risk factors that predisposed them to drug-induced QT prolongation and ventricular arrhythmias. We briefly review the mechanisms for torsades de pointes caused by QT-prolonging medications, describe characteristics that increase patients' susceptibility to drug-induced QT prolongation, and call attention to the risk of ventricular arrhythmias in patients who are given ondansetron.

scholarly journals An explainable algorithm for detecting drug-induced QT-prolongation at risk of torsades de pointes (TdP) regardless of heart rate and T-wave morphology

2021 ◽  
Vol 131 ◽  
pp. 104281
Author(s):  
Alaa Alahmadi ◽  
Alan Davies ◽  
Jennifer Royle ◽  
Leanna Goodwin ◽  
Katharine Cresswell ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Rate ◽  
Torsades De Pointes ◽  
Qt Prolongation ◽  
Drug Induced ◽  
T Wave ◽  
Wave Morphology

Abstract 14311: Qt Interval Correlation Between Telemetry and 12-lead Electrocardiogram

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohamed Farhan Nasser ◽  
Ahmad Jabri ◽  
Saima Karim ◽  
Elizabeth Kaufman
Keyword(s):  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Qt Prolongation ◽  
T Wave ◽  
Qt Intervals ◽  
Increased Risk ◽  
Tangent Method ◽  
Wave Morphology ◽  
Monitoring Service ◽  
Inpatient Units

Introduction: QT prolongation is associated with increased risk of ventricular arrhythmias.As many patients with COVID19 may be started on QT prolonging drugs, measuring and monitoring QT is imperative to prevent fatal ventricular arrhythmias. However, we need to limit exposure of staff to patients with confirmed COVID19 and judiciously use personal protective equipment. Thus, it is important to find alternatives to doing frequent 12-lead ECGs. Hypothesis: We hypothesize that the QT interval measured from telemetry is similar to the QT interval on 12-lead ECG. Methods: Telemetry recordings and 12-lead ECGs were obtained from 15 patients at the same time and identical heart rates. Patients were from two different inpatient units with the same telemetry monitoring service. QT intervals were measured manually using calipers with the tangent method, excluding U waves. Telemetry recordings included lead I and II or a precordial lead. QT from telemetry was compared to the corresponding leads and to the longest QT on the 12-lead ECG. In cases of atrial fibrillation (AF), the QT from all the complexes was averaged. Results: Of 15 patients, 2 were in AF and 2 had RBBB. One patient had abnormal T-wave morphology and QT prolongation (abnormal repolarization). In all patients, QT intervals from the same leads as telemetry matched the QT measured from 12-lead. In 14 of 15 patients, telemetry QT matched the longest QT on the 12-lead ECG. However, in the patient with abnormal repolarization, maximum QT on 12-lead ECG was substantially longer than telemetry QT (Figure 1). Conclusion: When using the same lead, QT intervals were identical on telemetry and 12-lead ECG. However, in the patient with abnormal repolarization, the longest QT on 12-lead ECG was not represented on telemetry. In patients with abnormal repolarization on 12-lead ECG, we recommend serial 12-lead ECGs while on QT-prolonging drugs. Telemetry may suffice as a surrogate for 12-lead ECG to follow QT intervals in most patients.

scholarly journals Managing drug-induced QT prolongation in clinical practice

2020 ◽  
pp. postgradmedj-2020-138661
Author(s):  
Rani Khatib ◽  
Fatima R N Sabir ◽  
Caroline Omari ◽  
Chris Pepper ◽  
Muzahir Hassan Tayebjee
Keyword(s):  
Qt Interval ◽  
Simple Algorithm ◽  
Torsades De Pointes ◽  
Daily Practice ◽  
Qt Prolongation ◽  
Key Factors ◽  
Drug Induced ◽  
Electrolyte Disturbances ◽  
Related Risk ◽  
Life Threatening

Many drug therapies are associated with prolongation of the QT interval. This may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia. As the QT interval varies with a change in heart rate, various formulae can adjust for this, producing a ‘corrected QT’ (QTc) value. Normal QTc intervals are typically <450 ms for men and <460 ms for women. For every 10 ms increase, there is a ~5% increase in the risk of arrhythmic events. When prescribing drugs associated with QT prolongation, three key factors should be considered: patient-related risk factors (eg, female sex, age >65 years, uncorrected electrolyte disturbances); the potential risk and degree of QT prolongation associated with the proposed drug; and co-prescribed medicines that could increase the risk of QT prolongation. To support clinicians, who are likely to prescribe such medicines in their daily practice, we developed a simple algorithm to help guide clinical management in patients who are at risk of QT prolongation/TdP, those exposed to QT-prolonging medication or have QT prolongation.

scholarly journals Use of QT Prolonging Medications by Hemodialysis Patients and Individuals Without End‐Stage Kidney Disease

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Magdalene M. Assimon ◽  
Lily Wang ◽  
Patrick H. Pun ◽  
Wolfgang C. Winkelmayer ◽  
Jennifer E. Flythe
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Cardiac Death ◽  
Medication Use ◽  
Torsades De Pointes ◽  
Hemodialysis Patients ◽  
Qt Prolongation ◽  
End Stage Kidney Disease ◽  
Drug Induced ◽  
End Stage

Background The rate of sudden cardiac death in the hemodialysis population exceeds that of the general population by >20‐fold. Hemodialysis patients may be particularly susceptible to sudden cardiac death provoked by drug‐induced QT prolongation because of their substantial cardiovascular disease burden, exposure to electrolyte shifts during dialysis, and extensive polypharmacy. However, population‐specific data regarding the frequency and patterns of QT prolonging medication use are limited. Methods and Results We conducted a descriptive drug utilization study using 3 administrative databases, the United States Renal Data System, MarketScan, and Medicare claims. We characterized the extent and patterns of QT prolonging medication use by adult hemodialysis patients and individuals without end‐stage kidney disease annually from 2012 to 2016. We also identified instances of high‐risk QT prolonging medication use among hemodialysis patients. In total, 338 515 hemodialysis patients and 40.7 million individuals without end‐stage kidney disease were studied. Annual utilization rates of QT prolonging medications with known torsades de pointes risk in hemodialysis patients were ~1.4 to ~2.5 times higher than utilization rates in individuals without end‐stage kidney disease. Hemodialysis patients with demographic and clinical risk factors for drug‐induced QT prolongation were exposed to medications with known torsades de pointes risk more often than patients without risk factors. Conclusions Hemodialysis patients use QT prolonging medications with known torsades de pointes risk more extensively than individuals without end‐stage kidney disease. Given the widespread use and instances of high‐risk prescribing, future studies evaluating the cardiac safety of these drugs in the hemodialysis population are needed.

Azithromycin and the Risk of Cardiovascular Complications

2013 ◽  
Vol 27 (5) ◽  
pp. 496-500 ◽  
Author(s):  
Nicole M. Maisch ◽  
Jenny G. Kochupurackal ◽  
Jonathan Sin
Keyword(s):  
Cohort Study ◽  
Case Reports ◽  
Torsades De Pointes ◽  
Cardiac Risk ◽  
Cardiovascular Death ◽  
Cardiovascular Complications ◽  
Qt Prolongation ◽  
Baseline Risk ◽  
Cardiac Events ◽  
Increased Risk

The purpose of this review was to evaluate the literature to assess the incidence and true clinical relevance of recent Food and Drug Administration warnings regarding QT prolongation with azithromycin, given its widespread use, with over 40 million US outpatient prescriptions written in 2011. A literature search of MEDLINE (1946 to May 2013) and International Pharmaceutical Abstracts (1970 to May 2013) was conducted using the terms azithromycin, QT prolongation, torsades de pointes, arrhythmia, and cardiovascular death. A bibliographic search was also performed. Several relevant studies and case reports were identified and reviewed. One cohort study revealed an increased risk of cardiovascular death with azithromycin compared to no antibiotic, especially in those with higher cardiovascular risk. Another cohort study comparing azithromycin, penicillin V, and no antibiotic in a younger Danish population with less cardiac risk found no increased cardiovascular death associated with azithromycin use. The majority of case reports involved ill and/or elderly patients with multiple comorbidities and concomitant medications who were already at a higher risk of cardiovascular events. Although there is evidence that azithromycin may induce QT prolongation and adverse cardiac events, the incidence is fairly limited to patients with high baseline risk, including those with preexisting cardiovascular conditions and concomitant use of other QT-prolonging drugs.

Characteristics and factors affecting mortality of patients admitted for chemotherapy in the United States during the year 2017.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19025-e19025
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Rashmi Verma
Keyword(s):  
Average Length ◽  
Private Insurance ◽  
Progression Free Survival ◽  
The United States ◽  
Factors Affecting ◽  
Beneficial Effects ◽  
Average Length Of Stay ◽  
Icd 10 ◽  
Life Threatening

e19025 Background: Over the past two decades, there has been a tremendous increase in the chemotherapy options available to cancer patients. In terms of overall, progression-free survival, and temporary suppression of cancer-related symptoms, chemotherapy has shown beneficial effects. However, the side effects of chemotherapy are sometimes life threatening which affects an individual’s physical health, emotional state and quality of life. There is a considerable increase in the prevention, early identification and timely management of toxicities associated with chemotherapy; however, chemotherapy-related deaths still occur. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2017. Patients who were admitted for the administration of chemotherapy are identified using ICD- 10 codes. The epidemiology, the role of insurance providers in the treatment outcome were studied. Results: A total of 29,018 hospitalizations for the administration of chemotherapy were there in 2017. The median age of patients who received chemotherapy was 48. The overall mortality related to chemotherapy admissions was 0.80% (n = 233). The mortality of females who were admitted for chemotherapy did not vary much when compared to males admitted for chemotherapy (0.89% vs 0.73%, p = 0.132). It was found that admissions for chemotherapy during weekend had 85 % higher odds of dying as compared to admission during weekdays (1.6% vs 0.76%, OR = 1.85, p = 0.001, CI = 1.16 – 2.95). Patients who were admitted electively for chemotherapy were 74% less likely to die in hospital when compared to those who were admitted emergently for chemotherapy (1.4 % vs 0.49% OR = 0.36, p = 0.001, CI = 0.266 – 0.49). Interestingly, patients who had Medicare and Medicaid had higher mortality than those who had private insurance and self-pay when admitted for chemotherapy (2.08 % vs 0.58% vs 0.36%, p = 0.00). Those who had private insurance were 60% less likely to die in hospital while admitted for chemotherapy. The average length of stay for chemotherapy admissions were 5.92 ± 7.9%. Conclusions: Medicare and Medicaid patients, weekend admissions and emergent admissions were more likely to die in hospital while admitted for chemotherapy. Further studies are needed to reveal the disparities in the mortality of chemotherapy admissions, based on the socioeconomic status and the insurance payers.

Abstract P391: The Effects of Obstructive Sleep Apnea on Cardiac Arrhythmia Risk

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Emily Biben ◽  
Lauren Burgess ◽  
Julie Allen ◽  
Noah Jouett ◽  
John Burk ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Disease ◽  
Qt Interval ◽  
The United States ◽  
Qt Prolongation ◽  
Qtc Interval ◽  
Sleep Study ◽  
Qt Intervals ◽  
Obstructive Sleep

Background: Over 20 million people in the United States suffer from Obstructive Sleep Apnea (OSA). Compared to the general population, OSA patients are 2.6 times more likely to experience sudden cardiac death (SCD), and it is suspected that this is due, in part, to QT prolongation leading to fatal dysrhythmias. OSA events have previously been shown to cause prolonged QT intervals compared to the post-apnea hyperventilation period, and studies have also observed increased QT dispersion in patients without cardiac disease. However, those with cardiac disease may be at the greatest risk for SCD, and it is not known what role QT prolongation plays and what factors influence these responses. Thus, the purpose of this study is to evaluate the factors that affect QT interval during periods of sleep apnea including OSA severity, time of night, and quantity of obstructive apneic events during sleep. Methods: We determined QTc intervals from the electrocardiograms of 36 patients undergoing polysomnography for diagnosis of OSA. Patients that were selected had an apnea hypopnea index >20/Hr and had no prior myocardial infarction or heart failure. Each patient’s ECG during their sleep study was analyzed to assess QT interval throughout the night. Baseline QT intervals were compared to QT intervals during obstructive apneas during the first 2 hours of sleep (Early) and last 2 hours of sleep (Late). In addition, apneas >40 seconds were analyzed in 11 patients for changes in QTc as the apnea progressed. Statistical comparisons were made with paired t tests and a one-way ANOVA analysis with repeated measures. Results: Early analyses of data showed QTc intervals in Early and Late apneas were significantly prolonged compared to awake baseline (p=0.04 and p=0.006 respectively). For patients with apneas >40 seconds, significant differences in QTc interval were observed at increasing time points during the apnea compared to the QTc immediately preceding the apnea (p<0.001). Furthermore, patients with longer apneas tend to have longer baseline QTc (p=0.07). Conclusions: Sleep apneic events are associated with periods of mild QTc prolongation despite some cardiac cycle shortening. The prolongation tends to become enhanced later in the night, implying that there is a cumulative effect of numerous prior apneas. Furthermore, prolongation tends to increase as the apnea duration progresses. Early data analyses also suggest that baseline QTc tends to be longer in patients who have more severe/longer apneic events throughout the night. Future studies will focus on QTc changes in OSA patients with prior heart disease, as these are the patients at greatest risk for serious arrhythmias during the night.

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