Recommendations for the measurement of the QT interval during the use of drugs for COVID-19 infection treatment. Updatable in accordance with the availability of new evidence

Abstract

COVID-19 infection has shown rapid growth worldwide, and different therapies have been proposed for treatment, in particular, the combination of immune response modulating drugs such as chloroquine and hydroxychloroquine (antimalarials) alone or in combination with azithromycin. Although the clinical evidence supporting their use is scarce, the off label use of these drugs has spread very quickly in face of the progression of the epidemic and the high mortality rate in susceptible populations. However, these medications can pathologically prolong the QT interval and lead to malignant ventricular arrhythmias such that organized guidance on QT evaluation and management strategies are important to reduce morbidity associated with the potential large-scale use. COVID-19 infection has shown rapid growth worldwide, and different therapies have been proposed for treatment, especially in critical patients with acute respiratory failure. One of these therapeutic strategies suggests the use of immune response modulating drugs such as chloroquine and hydroxychloroquine (antimalarials) alone or in combination with azithromycin (macrolide antibiotic); the use of antivirals such as ritonavir and lopinavir have also been suggested. Although the clinical evidence supporting their use is scarce and mostly limited to in vitro studies, the off label use of these drugs as first-line therapy and even as prophylaxis has spread very quickly in face of the progression of the epidemic and the high mortality rate in susceptible populations. However, it is very important to note that all of these medicines can pathologically prolong the QT interval in patients at high risk by genetic predisposition (with congenital long QT syndrome or in patients with polymorphisms but without phenotypic expression) or those with acquired predisposition. This risk may be further increased by the wide interaction of these drugs with countless medications such as antibiotics, antiarrhythmics, anesthetics, and muscle relaxants, among others (http://www.covid19-druginteractions.org/). For these reasons, an increase in the occurrence of malignant arrhythmias such as “torsade de pointes” or ventricular fibrillation with indiscriminate use of these drugs is expected if preventive measures are not established.