Published online Dec 28, 2021. doi: 10.13105/wjma.v9.i6.557
Peer-review started: June 17, 2021
First decision: July 30, 2021
Revised: August 1, 2021
Accepted: November 5, 2021
Article in press: November 5, 2021
Published online: December 28, 2021
Processing time: 193 Days and 21.1 Hours
Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019 (COVID-19), these drugs are still the only options available. Moreover, the safety of these drugs is yet to be confirmed. A serious concern is the occurrence of various cardiac arrhythmias, particularly QT prolongation.
To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment (hydroxychloroquine alone or in combination with azithromycin) for COVID-19.
We comprehensively searched Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials databases until October 31, 2020 for all eligible studies under the considered keywords COVID-19, arrhythmia, QT interval, therapy, azithromycin, and hydroxychloroquine until. The study protocols were established in compliance with PRISMA-P guidelines (Preferred Reporting Items for Systematic Review and Meta-Analysis – Protocols), and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies. Outcome measures were corrected QT (QTc) prolongation, cardiac arrhythmias, or sudden cardiac death.
Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included. The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766. The pooled prevalence rate of QTc prolongation was estimated to be 9.2% (95% confidence interval: 4.5% to 18.1%).
Hydroxychloroquine ± azithromycin regimen can significantly increase the risk of developing QTc prolongation.
Core Tip: Given the greater importance of coronavirus disease 2019 worldwide, there is an ongoing controversy about the potential harms of anti-viral agents in which caused uncertainties in daily clinical practice. Given the unresolved debate, during this systematic review and meta-analysis, we investigated the association of Hydroxychloroquine (alone or in combination with azithromycin) with the risk of QT interval prolongation, cardiac arrhythmias, and sudden cardiac death. Although there are some studies about the effects of these agents, there are scarce systematic reviews and meta-analyses about both QT prolongation and risk of cardiac arrhythmias which is a distinguishing point for our study.