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Am. J. Trop. Med. Hyg., 80(1), 2009, pp. 126-132
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Does Artesunate Prolong the Electrocardiograph QT Interval in Patients with Severe Malaria?

Richard J. Maude*, Katherine Plewes, M. Abul Faiz, Josh Hanson, Prakaykaew Charunwatthana, Sue J. Lee, Joel Tärning, Emran Bin Yunus, M. Gofranul Hoque, Mahatab Uddin Hasan, Amir Hossain, Niklas Lindegardh, Nicholas P. J. Day, Nicholas J. White, AND Arjen M. Dondorp
Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Dhaka Medical College, Dhaka, Bangladesh; Chittagong Medical College Hospital, Chittagong, Bangladesh

Several antimalarials can cause significant prolongation of the electrocardiograph QT interval, which can be associated with an increased risk of potentially lethal ventricular arrhythmias. High doses of artemether and artemotil have been associated with QT prolongation in dogs, raising the possibility of a class effect with the artemisinin derivatives. Serial electrocardiograms were recorded, and QTc interval was calculated before and after administration of artesunate by intravenous injection in patients with severe falciparum malaria in Bangladesh. Of 21 adult patients with severe malaria enrolled, 8 (38%) died. The mean QTc interval was unaffected by bolus intravenous artesunate (2.4 mg/kg). In two patients, the QTc interval exceeded 0.5 seconds, but in both cases, an alternative explanation was plausible. No effect was observed on the JTc or PR interval, QRS width, blood pressure, or heart rate. Intravenous artesunate does not have significant cardiovascular effects in patients with severe falciparum malaria.

Received July 2, 2008. Accepted for publication September 25, 2008.

* Address correspondence to Richard J. Maude, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Rajvithi Road, Rajthevee, Bangkok 10400, Thailand. E-mail: richard{at}tropmedres.ac

Authors’ addresses: Richard J. Maude, Katherine Plewes, Josh Hanson, Prakaykaew Charunwatthana, Sue J. Lee, Joel Tärning, Niklas Lindegardh, Nicholas P. J. Day, Nicholas J. White, and Arjen M. Dondorp, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Rajvithi Road, Rajthevee, Bangkok 10400, Thailand, E-mail: richard{at}tropmedres.ac. M. Abul Faiz, Dhaka Medical College, Dhaka, Bangladesh. Emran Bin Yunus, M. Gofranul Hoque, Mahatab Uddin Hasan, and Amir Hossain, Chittagong Medical College Hospital, Chittagong, Bangladesh.






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