Effects of treatment with hydroxychloroquine and azithromycin on the index of cardiac electrophysiological balance in patients with COVID-19: A retrospective cohort study

Songül Araç; Mehmet Zülkif Karahan; Mehmet Özel; Ramazan Yiğit; Hasan Akkoç; Eşref Araç

doi:10.28982/josam.843042

Authors

Songül Araç https://orcid.org/0000-0001-6830-3639
Mehmet Zülkif Karahan https://orcid.org/0000-0001-8145-9574
Mehmet Özel https://orcid.org/0000-0002-4797-7017
Ramazan Yiğit Ergani Devlet Hastanesi https://orcid.org/0000-0002-0420-6837
Hasan Akkoç https://orcid.org/0000-0003-2836-2452
Eşref Araç https://orcid.org/0000-0001-6041-3817

DOI:

https://doi.org/10.28982/josam.843042

Keywords:

COVID-19, Hydroxychloroquine, Azithromycin, ECG, iCEB, Tp-e interval

Abstract

Background/Aim: The common cardiac toxicities of hydroxychloroquine (HCQ) and azithromycin (AZ) are not well defined in COVID-19 patients. Index of cardiac electrophysiological balance (iCEB) is used as a novel risk marker for drug-induced arrhythmias. The purpose of this study was to evaluate ventricular repolarization using iCEB and other conventional ECG parameters such as the end of electrocardiographic T wave (Tp-e) interval, Tp-e/QT ratio, and Tp-e/ heart rate-corrected QT (QTc) ratio in COVID-19 patients treated with HCQ and AZ. Methods: This retrospective study enrolled 164 patients diagnosed with COVID-19 pneumonia in the Emergency Department (ED) and then transferred to the ward or the intensive care unit in April 2020. Results: A total of 164 patients with a mean age of 47 (18) years (range: 18-97 years) included 83 (50.6%) females. There were 38 and 126 patients in Groups HTQ and HTQ+AZ, respectively. On the 5th day of hospitalization, all patients’ heart rates were significantly lower (P<0.001), while QTc, QT max (V5-V6), QTmin, Tp-e (V5-V6), and iCEB values were significantly higher (P=0.01 and P<0.001 for the rest, respectively) compared to the basal values measured in the ED (P<0.001). iCEB values of the HTZ+AZ group were significantly higher than those of the HTQ group (P=0.03). iCEBc strongly positively correlated with Tp-e/QT (V5), and strongly negatively correlated with Tp-e (V5). Conclusion: The iCEB values were increased after HTQ and AZ treatment among COVID-19 patients, and strongly correlated with Tp-e and Tp-e/QT. iCEB is a simple, non-invasive method that can be a useful marker to evaluate ventricular repolarization in COVID-19 patients.

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