Anales De Pediatria (Barcelona, Spain : 2003) | 2021
Evolución del intervalo QTc en pacientes con infección SARS-CoV-2 tratados con fármacos antivirales☆
Abstract
\n Introducción. Muchos antivirales, como hidroxicloroquina, se han utilizado para el tratamiento de COVID-19. La prolongación del QTc es un efecto adverso preocupante, escasamente estudiado en pediatría.\n Pacientes y métodos. Los pacientes pediátricos con COVID-19 que recibieron tratamiento antiviral se emparejaron (1:2) con controles no infectados ni expuestos al tratamiento. Se analizaron prospectivamente los electrocardiogramas basal, en las primeras 72 horas de tratamiento y posterior a 72 horas.\n Resultados. Once (22,9%) de 48 pacientes pediátricos ingresados por COVID-19 (Marzo-Julio 2020) recibieron terapia antiviral. Todos presentaban patologías de base; destacando cardiopatías (4/11; 36,4%) e inmunosupresión (3/11; 27,3%); 5/11 (45,5%) recibían tratamiento de base con potencial efecto sobre el QTc. No hubo diferencias en el QTc basal entre casos y controles: 414,8ms (49,2) vs 416,5ms (29,4) (p=0,716). Se observó QTc prolongado basal en 2/11 casos y 2/22 controles. De los casos, 10/11 (90,9%) recibieron hidroxicloroquina, principalmente asociada a azitromicina (8/11; 72,7%); tres recibieron lopinavir/ritonavir, uno remdesivir. La mediana de incremento del QTc tras 72 horas fue de 28,9ms [RIC 48,7] (p=0,062); 4/11 (36,4%) presentaron un QTc largo, de los cuáles en tres ≥500ms. En uno se paró el tratamiento (QTc 510ms) pero no se documentaron arritmias ventriculares.\n Conclusiones. El uso de fármacos antivirales causó un incremento del QTc tras 72 horas de tratamiento, considerándose un QTc largo en el 36,4% de los pacientes, aunque no se objetivaron eventos arrítmicos. El uso de hidroxicloroquina y antivirales requiere monitorización activa del QTc y se recomienda suspender el tratamiento si el QTc >500ms.\n \n 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.\n Patients and methods. Paediatric 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 hours in treatment and after 72 hours.\n 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: 414.8ms (49.2) vs 416.5ms (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 hours under treatment was 28.9 ms [IQR 48.7] (p=0.062). 4/11 (36.4%) patients had a long QTc at 72 hours, resulting in 3 patients ≥500ms; treatment was stopped in one (QTc 510ms) but ventricular arrhythmias were not documented.\n Conclusions. The use of antivirals caused an increase on the QTc interval after 72 hours 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 >500ms.\n