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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Cohort study to assess the prevalence of prolonged QT and arrhythmias in critica...
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Vol. 70. Issue 10.
Pages 561-568 (December 2023)
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Vol. 70. Issue 10.
Pages 561-568 (December 2023)
Original article
Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic
Estudio de cohortes para evaluar la prevalencia de QT prolongado y arritmias en pacientes críticos durante la primera fase de la pandemia por COVID-19
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M. Zaballosa,b,
Corresponding author
mati@plagaro.net

Corresponding author.
, I. Fernándeza, L. Rodrígueza, S. Álvarez-Zaballosc, P. Duquea, E. Terradillosd, P. Piñeiroa, I. Garuttia,e, J.E. Guerrerof, J. Hortala,e
a Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense, Madrid, Spain
c Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Oberärztin, Institut für Anästhesiologie und Intensivmedizin, San Galo, Sankt Gallen, Switzerland
e Departamento de Farmacología, Universidad Complutense, Madrid, Spain
f Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tables (2)
Table 1. Demographic and clinical characteristics of patients with QTc interval ≥450 ms (men) and 460 ms (women) and QTc ≤450 (men) and 460 ms (women).
Table 2. Frequency and type of arrhythmias in critically ill COVID-19 patients.
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Abstract
Introduction

Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients.

Methods

Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded.

Results

A total of 77 patients with a mean age of 62 ± 13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc.

Conclusions

In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.

Keywords:
COVID-19
QTc interval
Arrhythmias
Critically ill patients
Resumen
Antecedentes y Objetivo

Los pacientes con infección por SARS-CoV-2 pueden presentar afectación cardiovascular incluyendo miocarditis, arritmias y prolongación del intervalo QT. Nuestro objetivo fue evaluar el impacto del COVID-19 y su tratamiento en la repolarización ventricular y desarrollo de arritmias en pacientes críticos.

Material y métodos

Estudio de cohortes retrospectivo de pacientes críticos con infección confirmada por SARS-CoV-2 durante un periodo de 3 meses. Se registraron datos clínicos relevantes y tratamiento específico administrado para el COVID-19. Se consideró QTc prolongado cuando medía ≥460 ms en mujeres y ≥450 ms en hombres. Se registró la incidencia y tipo de arritmias durante el mismo periodo.

Resultados

Se evaluaron 77 pacientes con una edad media de 62 ± 13 años, 20 mujeres y 57 hombres. Un 60% de los pacientes era hipertenso, un 52% presentaban un IMC > 30, y el 70% desarrollaron fracaso renal agudo durante el ingreso. Un 56% de los pacientes presentó prolongación del QTc. El 44% presentaron algún tipo de arritmia durante su estancia en la UCI, siendo en un 21% arritmias auriculares. La mortalidad global fue del 53%, sin diferencias entre los pacientes con o sin QTc prolongado.

Conclusiones

En nuestra serie, una elevada proporción de pacientes críticos con COVID-19 han presentado QTc prolongado y arritmias. Los factores implicados se han relacionado con la elevación de biomarcadores cardiacos, la propia afectación miocárdica del virus y a la medicación concomitante recibida en la UCI.

Palabras clave:
COVID-19
Intervalo QTc
Arritmias
Pacientes críticos

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