Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Table 12 Summary of the recommendations that should be kept in mind when treatment with prolonging-QT interval are going to be used during coronavirus disease-2019 pandemic

Step-by-step approach to administer prolonging-etc drugs during SARS-CoV-2 infection
1	QTc intervals should be monitored at baseline and at 4 h after the administration of any QTc-prolonging drug.
2	QTc interval monitoring previously to combine any drugs prolonging the QTc interval or CYP3A4-inhibiting drugs.
3	QTc interval monitoring in patients with Known LQTS, acquired QT prolongation, or conditions associated with acquired QT prolongation (e.g, use of other QT-prolonging drugs, underlying heart disease, bradycardia, liver and renal disease electrolyte alterations…)
4	Serum potassium, calcium and magnesium should be evaluated at baseline and monitored and optimized daily.
5	Avoiding hypokalaemia is not enough. Patients with acquired LQTS or patients using a combination of QT-prolonging drugs should have a high serum potassium level (5 mEq/L).
If QTc increases by > 60 milliseconds or absolute QTc > 500 milliseconds (or > 530-550 milliseconds if QRS > 120 milliseconds) is observed
1	Consultation with a pediatric cardiologist (“QT specialist”) for guidance in case of important QT prolongation. A careful balance of pros and cons should guide the decision to discontinue therapy.
2	Intensified ECG monitoring
3	Raising potassium levels
4	Correct QT-prolonging factors (calcium, magnesium, potassium…)
5	Consider to increase beta-blocker dosage

COVID-19: Coronavirus disease-2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.