Fatal arrhythmias: Another reason why doctors remain cautious about chloroquine/hydroxychloroquine for treating COVID-19

• Type of Material: Article
• Authors: Ilija Uzelac, Georgia Institute of Technology; Shahriar Iravanian, Emory University; Hiroshi Ashikaga, Johns Hopkins University; Neal Bhatia, Emory University; Conner Herndon, Georgia Institute of Technology; Abouzar Kaboudian, Georgia Institute of Technology; James C. Gumbart, Georgia Institute of Technology; Elizabeth M. Cherry, Georgia Institute of Technology; Flavio H. Fenton, Georgia Institute of Technology
• Language: English
• Date: 2020-09-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Heart Rhythm Society
• Final Published Version (URL): http://dx.doi.org/10.1016/j.hrthm.2020.05.030
• Title of Journal or Parent Work: HEART RHYTHM
• Volume: 17
• Issue: 9
• Start Page: 1445
• End Page: 1451
• Grant/Funding Information: This study was supported by grants NIH 1R01HL143450-01 and NSF 1446675. Drs Uzelac, Herndon, Kaboudian, Cherry, and Fenton.
• Keywords: Action potential duration dispersion; REPOLARIZATION; T-wave alternans; Life Sciences & Biomedicine; Science & Technology; HEART; Hydroxychloroquine; Long QT syndrome; Cardiovascular System & Cardiology; Arrhythmias; Experimental optical mapping; Cardiac & Cardiovascular Systems
• Research Categories: Physics, General; Health Sciences, Medicine and Surgery

Abstract

Background: Early during the current coronavirus disease 19 (COVID-19) pandemic, hydroxychloroquine (HCQ) received a significant amount of attention as a potential antiviral treatment, such that it became one of the most commonly prescribed medications for COVID-19 patients. However, not only has the effectiveness of HCQ remained questionable, but mainly based on preclinical and a few small clinical studies, HCQ is known to be potentially arrhythmogenic, especially as a result of QT prolongation. Objective: The purpose of this study was to investigate the arrhythmic effects of HCQ, as the heightened risk is especially relevant to COVID-19 patients, who are at higher risk for cardiac complications and arrhythmias at baseline. Methods: An optical mapping technique utilizing voltage-sensitive fluorescent dyes was used to determine the arrhythmic effects of HCQ in ex vivo guinea pig and rabbit hearts perfused with the upper therapeutic serum dose of HCQ (1000 ng/mL). Results: HCQ markedly increased action potential dispersion, resulted in development of repolarization alternans, and initiated polymorphic ventricular tachycardia. Conclusion: The study results further highlight the proarrhythmic effects of HCQ.