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



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


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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How to Cite

Araç S, Karahan MZ, Özel M, Yiğit R, Akkoç H, Araç E. Effects of treatment with hydroxychloroquine and azithromycin on the index of cardiac electrophysiological balance in patients with COVID-19: A retrospective cohort study. J Surg Med [Internet]. 2021 May 1 [cited 2024 Jul. 16];5(5):412-6. Available from: https://jsurgmed.com/article/view/843042