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493 the above-mentioned drugs, risk factors of arrhythmia should be taken into account prior to treatment administration (TABLE 2) and, if possible, eradicated. Electrolyte imbalance ought to be corrected, other drugs causing QT prolongation should be discontinued. Lists of QT prolonging drugs is available at www.qtdrugs.org and www.crediblemeds.org. Throughout the treatment of high-risk patients, monitoring of the QTc interval and arrhythmia is necessary (management algorithm is presented in FIGURE 1). In order to calculate the QTc interval, the Bazett formula is most commonly used. In case of problems when measuring QT (measuring the end of the T wave), a tangent to descending portion of the T wave should be drawn. The result should be an average of at least 3 heart evolutions (FIGURE 3). The upper limit of a QTc interval for men is 450 ms and for women, 460 ms. QTc between 460 ms and 500 ms requires attention. Introduction The purpose of this document is neither to evaluate the efficiency of treatment with antiviral and antimalarial drugs in patients with coronavirus disease 2019 (COVID-19), nor to influence the decision on the kind of treatment. The aim of the paper is to draw the attention to the possibility of reducing the risk of sudden cardiac death involving the use of these drugs as well as to ensure the utmost safety for patients requiring such treatment. Some drugs used in the treatment of COVID-19 (chloroquine, hydroxychloroquine, lopinavir / ritonavir, and azithromycin) may prolong QT / corrected QT (QTc) and cause serious arrhythmias such as torsade de pointes (TdP), an atypical ventricular tachycardia. The induction of such arrhytmias may lead to the loss of consciousness and possibly the cause of sudden cardiac death. Azithromycin can additionally cause polymorphic tachycardia and atrioventricular conduction disturbances (TABLE 1). In order to minimize the risk associated with Correspondence to: Prof. Elżbieta K. Biernacka, MD, PhD, Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland, phone: +48 22 343 44 00, email: k.biernacka@ikard.pl Received: May 10, 2020. Accepted: May 11, 2020. Published online: May 11, 2020. Kardiol Pol. 2020; 78 (5): 493-497 doi:10.33963/KP.15354 Copyright by the Polish Cardiac Society, Warsaw 2020

kardiologia polska

Safety of antiviral and anti-inflammatory drugs prolonging QT interval in patients with coronavirus disease 2019: an opinion of the Heart Rhythm Section of the Polish Cardiac Society