Prevalência de arritmias em pacientes com Sars-cov-2 tratados com hidroxicloroquina e azitromicina / Prevalence of arrhytmias in patients with Sars-cov-2 treated with hydroxychloroquine and azithromycin

Authors

  • Beatriz Gomes Dalla Justina
  • Caroline Marques de Aquino
  • Diana Neves Ladeia
  • Eduarda Faria do Nascimento
  • Gustavo Mariano Rodrigues Santos
  • Israel Souza da Silva Ramos
  • Ludmila Limpias Terrazas Binkowski
  • Pedro Duarte Moreira Andrade
  • Rodrigo Silas Lara Ferreira
  • Vinícius Catto Vaz

DOI:

https://doi.org/10.34119/bjhrv3n4-344

Keywords:

COVID-19, Torsade de Pointes, Hidroxicloroquina, Azitromicina, Intervalo QT.

Abstract

INTRODUÇÃO: Este estudo tem como objetivo realizar uma revisão de narrativa a respeito da correlação entre o prolongamento do intervalo QT e desenvolvimento de Torsade de Pointes (TdP) em pacientes previamente diagnosticados com a COVID-19 e medicados com Hidroxicloroquina e Azitromicina. METODOLOGIA:  Foram realizadas buscas nas bases de dados PubMed/ MedLine utilizando-se os seguintes descritores: ‘’COVID-19”, ‘’hidroxicloroquine’’, “azithromycin”, “QTc interval”, ‘’arrhythmias’’ e ‘’cardiac’’ com ênfase nos resultados de até 1 ano. RESULTADOS: Um total de trinta e três artigos de periódicos internacionais foram selecionados, totalizando uma amostra de 1191 pacientes confirmados com COVID-19 e tratados com Hidroxicloroquina associado com Azitromicina. Estes pacientes que fizeram uso de HCQ em monoterapia desenvolveram menos anormalidades cardíacas e QTc > 500ms em comparação aos tratados com a combinação desses fármacos. DISCUSSÃO: O estudo identificou um prolongamento excessivo do intervalo qtc nos pacientes em uso combinado da medicação, além de algumas arritmias associadas, principalmente FA e TdP. No entanto, é necessária uma investigação mais ampla, com estudos que demonstrem eficácia no combate ao vírus sem o surgimento de efeitos deletérios. CONCLUSÃO: O desenvolvimento de TdP através do uso de Hidroxicloroquina + Azitromicina foi raro. Entretanto, foi significativo o número de pacientes que apresentaram prolongamento do intervalo QT, em particular aqueles que já possuíam alguma comorbidade.

References

CARRON, J.; et al. Clinical guidance for navigating the QTc-prolonging and arrhythmogenic potential of pharmacotherapy during the COVID-19 pandemic. Irish Journal of Medical Science, 2020.

CAVALCANTI, A. B.; et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. The New England Journal of Medicine, 2020.

CHORIN, E.; et al. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. HeartRhythm Society, p.03-09, 2020.

CHORIN, E.; et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nature Medicine, v. 26, n.2, p. 808-809, 2020.

DAI, M.; et al. The QT Interval in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine/Azithromycin. Medrxiv, v. 11, 2020.

EL-SHERIF, N.; et al. Acquired long QT syndrome and torsade de pointes. Pacing Clinical Electrophysiology, v. 41, 4a ed, p. 414-421, 2018.

FDA, 2020. Disponível em: <https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or>

FREITAS, A. R. R.; NAPIMOGA, M.; DONALISIO, M. R. Análise da gravidade da pandemia de Covid-19. Epidemiol. Serv. Saúde, v. 29, n. 2, 2020.

GÉRARD, A.; et al. “Off-label” use of hydroxychloroquine, azithromycin, lopinavir-ritonavir and chloroquine in COVID-19: A survey of cardiac adverse drug reactions by the French Network of Pharmacovigilance Centers. Therapies, 2020.

JANKELSON, L.; et al. QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review. HeartRhythm Journal, v. 17, 5a ed, 2020.

MARAJ, I.; et al. Incidence and determinants of QT interval prolongation in COVID?19 patients treated with hydroxychloroquine and azithromycin. Journal of Cardiovascular Electrophysiology, v. 31, 8a ed, 2020.

MERCURO, N. J.; et al. Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19). Jama Cardiology, v. 323, n.1, p. 1834-1836, 2020.

MITRA, R. L.; et al. “An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine.” HeartRhythm case reports, vol. 6, p. 244–248, 2020.

MOSCHINI, L.; et al. Effects on QT interval of hydroxychloroquine associated with ritonavir/darunavir or azithromycin in patients with SARS-CoV-2 infection. Heart and Vessels, 2020.

PRIORI, S.; ZIPES, D. Morte cardíaca súbita: um manual para a prática clínica. John Wiley & Sons, 2009.

RAMIREDDY, A.; et al. Experience with Hydroxychloroquine and Azithromycin in the COVID-19 Pandemic: Implications for QT Interval Monitoring. Medrxiv, v. 11, 2020.

RODEN, D. M.; et al. Electrophysiology, Pacing and Arrhythmia. Clinical Cardiology, v. 16, 9a ed, p. 683-686, 1993.

RODEN, D. M. Predicting drug-induced QT prolongation and torsades de pointes. The Journal of Physiology, v. 594, 9a ed, p. 2459-2468, 2016.

SALEH, M.; et al. Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection. American Heart Association Journals, v. 13, 6a ed, 2020.

SHAN, S.; et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature, v. 581, p. 215-220, 2020.

TALASAZ, A. H.; et al. Cardiovascular Complications of COVID-19: Pharmacotherapy Perspective. Cardiovasc Drugs Ther, 2020.

UZELAC, I.; et al. Fatal arrhythmias: Another reason why doctors remain cautious about chloroquine/hydroxychloroquine for treating COVID-19. HeartRhythm Journal, v. 17, 5a ed, 2020.

VAN LAECKE, S. Hypomagnesemia and hypermagnesemia.International Journal of Clinical and Laboratory Medicine, v. 74, 1a ed, p. 41-47, 2019.

VOURI, S. M.; et al. An evaluation of co-use of chloroquine or hydroxychloroquine plus azithromycin on cardiac outcomes: A pharmacoepidemiological study to inform use during the COVID19 pandemic. Research in Social and Administrative Pharmacy, v. 16, n.4, p. 437-604, 2020.

YAO, X.; et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clinical Infectious Diseases, v. 71, 15a ed, p. 732-739, 2020.

WU, T. C.; et al. Controle do Intervalo QT para Prevenção de Torsades de Pointes Durante uso de Hidroxicloroquina e/ou Azitromicina em Pacientes com COVID 19. Arq. Bras. Cardiol, v. 114, n.6, 2020.

Published

08/28/2020

How to Cite

JUSTINA, B. G. D.; AQUINO, C. M. de; LADEIA, D. N.; NASCIMENTO, E. F. do; SANTOS, G. M. R.; RAMOS, I. S. da S.; BINKOWSKI, L. L. T.; ANDRADE, P. D. M.; FERREIRA, R. S. L.; VAZ, V. C. Prevalência de arritmias em pacientes com Sars-cov-2 tratados com hidroxicloroquina e azitromicina / Prevalence of arrhytmias in patients with Sars-cov-2 treated with hydroxychloroquine and azithromycin. Brazilian Journal of Health Review, [S. l.], v. 3, n. 4, p. 10876–10890, 2020. DOI: 10.34119/bjhrv3n4-344. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/15748. Acesso em: 17 oct. 2026.

Issue

Section

Original Papers