- Torsades de pointes is a polymorphic ventricular tachycardia that can cause syncope and lead to sudden cardiac death. This arrhythmia is initiated by early afterdepolarizations in the setting of prolonged ventricular repolarization, manifesting as QT prolongation on the 12-lead electrocardiogram (ECG).1 Common risk factors include QT-prolonging medications, electrolyte disturbances, bradycardia, and certain inherited genetic mutations.2 We report a case of torsades de pointes that occurred shortly after vaccination for COVID-19.
- (Hydroxy)chloroquine ((H)CQ) is being investigated as a treatment for COVID-19, but studies have so far demonstrated either no or a small benefit. However, these studies have been mostly performed in patients admitted to the hospital and hence likely already (severely) affected. Another suggested approach uses prophylactic (H)CQ treatment aimed at preventing either severe acute respiratory syndrome coronavirus 2 infection or the development of disease. A substantial number of clinical trials are planned or underway aimed at assessing the prophylactic benefit of (H)CQ.
- Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage.
- Many of the drugs being used in the treatment of the ongoing pandemic coronavirus disease 2019 (COVID-19) are associated with QT prolongation. Expert guidance supports electrocardiographic (ECG) monitoring to optimize patient safety.
- The case for chloroquine and hydroxychloroquine, as treatment of the coronavirus disease 2019 (COVID-19) pandemic, has been voiced not only in medical journals1 but also in the popular press.2 Not only is the efficacy of these antimalarial and anti-inflammatory compounds as antiviral drugs uncertain, but there is also an ongoing debate about their safety.3 In particular, the magnitude of the proarrhythmic potential of these drugs, specifically related to their QT prolongation effects, is questioned: On the one hand, the fact that chloroquine and hydroxychloroquine block the rapid component of the delay rectifier potassium current (Ikr) potassium channel at the myocyte level, therefore causing QT prolongation, is well documented.
- The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic owing to a newly identified coronavirus, SARS-CoV-2, originating in Wuhan, China, has resulted in significant morbidity and mortality around the world. Early reports have shown improved clinical outcome and viral clearance with the use of chloroquine and hydroxychloroquine.1,2