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Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales()
INTRODUCTION: Many antiviral agents, such as hydroxychloroquine, have been used to treat COVID-19, without being broadly accepted. QTc prolongation is a worrisome adverse effect, scarcely studied in pediatrics. PATIENTS AND METHODS: Pediatric patients affected from COVID-19 who received antivirals w...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057733/ https://www.ncbi.nlm.nih.gov/pubmed/33995537 http://dx.doi.org/10.1016/j.anpedi.2021.04.009 |
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author | Esmel-Vilomara, Roger Dolader, Paola Sabaté-Rotes, Anna Soriano-Arandes, Antoni Gran, Ferran Rosés-Noguer, Ferran |
author_facet | Esmel-Vilomara, Roger Dolader, Paola Sabaté-Rotes, Anna Soriano-Arandes, Antoni Gran, Ferran Rosés-Noguer, Ferran |
author_sort | Esmel-Vilomara, Roger |
collection | PubMed |
description | INTRODUCTION: Many antiviral agents, such as hydroxychloroquine, have been used to treat COVID-19, without being broadly accepted. QTc prolongation is a worrisome adverse effect, scarcely studied in pediatrics. PATIENTS AND METHODS: Pediatric patients affected from COVID-19 who received antivirals were matched (1:2) with controls not infected nor exposed. Electrocardiograms were prospectively analyzed at baseline, during the first 72 h in treatment and after 72 h. RESULTS: Eleven (22.9%) out of 48 patients admitted due to COVID-19 (March–July 2020) received antiviral therapy. All had underlying diseases: congenital heart disease (4/11; 36.4%) and immunosuppression (3/11; 27.3%) stand out. 5/11 (45.5%) received treatment at baseline with a potential effect on QTc. There where no differences observed in the baseline QTc between cases and controls: 414.8 ms (49.2) vs. 416.5 ms (29.4) (p = 0.716). Baseline long QT was observed in 2/11 cases and 2/22. Among cases, 10/11 (90.9%) received hydroxychloroquine, mainly associated with azithromycin (8/11; 72.7%), 3 received lopinavir/ritonavir and one remdesivir. The median increase in QTc after 72 h under treatment was 28.9 ms (IQR 48.7) (p = 0.062). 4/11 (36.4%) patients had a long QTc at 72 h, resulting in 3 patients ≥500 ms; treatment was stopped in one (QTc 510 ms) but ventricular arrhythmias were not documented. CONCLUSIONS: The use of antivirals caused an increase on the QTc interval after 72 h of treatment, being the QTc long in 36.3% of the patients, although no arrhythmic events were observed. The use of hydroxychloroquine and antivirals requires active QTc monitoring and it is recommended to discontinue treatment if QTc >500 ms. |
format | Online Article Text |
id | pubmed-8057733 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80577332021-04-21 Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() Esmel-Vilomara, Roger Dolader, Paola Sabaté-Rotes, Anna Soriano-Arandes, Antoni Gran, Ferran Rosés-Noguer, Ferran An Pediatr (Barc) Original INTRODUCTION: Many antiviral agents, such as hydroxychloroquine, have been used to treat COVID-19, without being broadly accepted. QTc prolongation is a worrisome adverse effect, scarcely studied in pediatrics. PATIENTS AND METHODS: Pediatric patients affected from COVID-19 who received antivirals were matched (1:2) with controls not infected nor exposed. Electrocardiograms were prospectively analyzed at baseline, during the first 72 h in treatment and after 72 h. RESULTS: Eleven (22.9%) out of 48 patients admitted due to COVID-19 (March–July 2020) received antiviral therapy. All had underlying diseases: congenital heart disease (4/11; 36.4%) and immunosuppression (3/11; 27.3%) stand out. 5/11 (45.5%) received treatment at baseline with a potential effect on QTc. There where no differences observed in the baseline QTc between cases and controls: 414.8 ms (49.2) vs. 416.5 ms (29.4) (p = 0.716). Baseline long QT was observed in 2/11 cases and 2/22. Among cases, 10/11 (90.9%) received hydroxychloroquine, mainly associated with azithromycin (8/11; 72.7%), 3 received lopinavir/ritonavir and one remdesivir. The median increase in QTc after 72 h under treatment was 28.9 ms (IQR 48.7) (p = 0.062). 4/11 (36.4%) patients had a long QTc at 72 h, resulting in 3 patients ≥500 ms; treatment was stopped in one (QTc 510 ms) but ventricular arrhythmias were not documented. CONCLUSIONS: The use of antivirals caused an increase on the QTc interval after 72 h of treatment, being the QTc long in 36.3% of the patients, although no arrhythmic events were observed. The use of hydroxychloroquine and antivirals requires active QTc monitoring and it is recommended to discontinue treatment if QTc >500 ms. Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría. 2022-03 2021-04-20 /pmc/articles/PMC8057733/ /pubmed/33995537 http://dx.doi.org/10.1016/j.anpedi.2021.04.009 Text en © 2021 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Pediatría. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Original Esmel-Vilomara, Roger Dolader, Paola Sabaté-Rotes, Anna Soriano-Arandes, Antoni Gran, Ferran Rosés-Noguer, Ferran Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title | Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title_full | Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title_fullStr | Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title_full_unstemmed | Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title_short | Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales() |
title_sort | evolución del intervalo qtc en pacientes con infección sars-cov-2 tratados con fármacos antivirales() |
topic | Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057733/ https://www.ncbi.nlm.nih.gov/pubmed/33995537 http://dx.doi.org/10.1016/j.anpedi.2021.04.009 |
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