• Ilija Uzelac, Shahriar Iravanian, Hiroshi Ashikaga, Neal K Bhatia, Conner Herndon, Abouzar Kaboudian, James C Gumbart, Elizabeth M Cherry, and Flavio H Fenton.
• School of Physics, Georgia Institute of Technology, Atlanta, Georgia.
• Heart Rhythm. 2020 Sep 1; 17 (9): 1445-1451.

BackgroundEarly 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.ObjectiveThe 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.MethodsAn 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).ResultsHCQ markedly increased action potential dispersion, resulted in development of repolarization alternans, and initiated polymorphic ventricular tachycardia.ConclusionThe study results further highlight the proarrhythmic effects of HCQ.Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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