Electrocardiographic profiles from 24-hour monitoring of COVID-19 patients treated with hydroxychloroquine and azithromycin

Abstract

Introduction: Azithromycin combined with hydroxychloroquine or chloroquine has been used as treatment for SARS-CoV-2, but prolongation of QTc interval and malignant arrhythmias have been reported as adverse events. The occurrence of these abnormalities in Honduran patients is unknown. Aim of the study: To determine the prevalence of cardiac arrhythmias and prolongation of the QTc interval in hospitalized COVID-19 patients treated with hydroxychloroquine plus azithromycin at Hospital General del Sur at Choluteca, Honduras. Methods: 24-hour electrocardiograms were performed in 21 patients over 18 years of age with COVID-19 stage II or III receiving treatment for seven days. Diagnosis was done by RT-PCR and/or with other accepted combined criteria. Analysis were done for QTc interval, supraventricular or ventricular arrhythmias, and heart rate variability. Results: Overall, 67% of patients were men and 33% had comorbidities (diabetes mellitus, high blood pressure and heart failure). Patients were hospitalized for at least 16 days. Median QTc interval was 410 milliseconds, median minimum heart rate 56 beats per minute, and median maximum heart rate 126 beats/minute. Four patients (19%) presented ventricular arrhythmias (<30 premature ventricular contractions in one hour, bigeminy, and a run of non-sustained monomorphic ventricular tachycardia). All patients showed QTc intervals less than 490 milliseconds. Conclusions: Frequency of ventricular arrhythmias during monitoring was in the lower ranges compared to similar studies. No prolongation of QTc interval was observed.