1.Smartphone electrocardiogram for QT interval monitoring in Coronavirus Disease 2019 (COVID-19) patients treated with Hydroxychloroquine
Andy Tze Yang Ko ; Lean Seng Chen ; Ing Xiang Pang ; Hwei Sung Ling ; Tze Cheng Wong ; Tonnii Loong Loong Sia ; Keng Tat Koh
The Medical Journal of Malaysia 2021;76(2):125-130
Introduction: The global pandemic of Corona Virus Disease
2019 (COVID-19) has led to the re-purposing of medications,
such as hydroxychloroquine and lopinavir-ritonavir in the
treatment of the earlier phase of COVID-19 before the
recognized benefit of steroids and antiviral. We aim to
explore the corrected QT (QTc) interval and ‘torsadogenic’
potential of hydroxychloroquine and lopinavir-ritonavir
utilising a combination of smartphone electrocardiogram
and 12-lead electrocardiogram monitoring.
Materials and Methods: Between 16-April-2020 to 30-April2020, patients with suspected or confirmed for COVID-19
indicated for in-patient treatment with hydroxychloroquine
with or without lopinavir-ritonavir to the Sarawak General
Hospital were monitored with KardiaMobile smartphone
electrocardiogram (AliveCor®, Mountain View, CA) or
standard 12-lead electrocardiogram. The baseline and serial
QTc intervals were monitored till the last dose of
medications or until the normalization of the QTc interval.
Results: Thirty patients were treated with
hydroxychloroquine, and 20 (66.7%) patients received a
combination of hydroxychloroquine and lopinavir-ritonavir
therapy. The maximum QTc interval was significantly
prolonged compared to baseline (434.6±28.2msec vs.
458.6±47.1msec, p=0.001). The maximum QTc interval
(456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta
QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not
significantly different between patients on
hydroxychloroquine or a combination of
hydroxychloroquine and lopinavir-ritonavir. Five (16.7%)
patients had QTc of 500msec or more. Four (13.3%) patients
required discontinuation of hydroxychloroquine and 3
(10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de
pointes was observed.
Conclusions: QTc monitoring using smartphone
electrocardiogram was feasible in COVID-19 patients treated
with hydroxychloroquine with or without lopinavir-ritonavir.
The usage of hydroxychloroquine and lopinavir-ritonavir
resulted in QTc prolongation, but no torsade de pointes or
arrhythmogenic death was observed.