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Cardiac disorders following off label use: 5 case reports In an observational cohort study involving 118 patients hospitalised between 26 March 2020 and 20 April 2020, 5 male patients including 4 men aged 63–77 years† [not all ages stated] were described, who developed prolongation of QT or QTc, isolated monomorphic ventricular extrasystole or atrial fibrillation following off label treatment with hydroxychloroquine and azithromycin for COVID-19 [routes and durations of treatments to reactions onsets not stated; not all outcomes stated]. Patient 1: A 63-year-old man, who was diagnosed with COVID-19, started receiving off label treatment with hydroxychloroquine 200mg twice daily and azithromycin 500mg on the first day followed by 250mg twice daily for 10 days. Subsequently, he developed QTc prolongation, as noted with ECG. He also had an underlying hypokalaemia. Patient 2: A 65-year-old man was diagnosed with COVID-19, and he started receiving off label treatment with hydroxychloroquine 200mg twice daily and azithromycin 500mg on the first day followed by 250mg twice daily for 10 days. Subsequently, he developed isolated monomorphic ventricular extrasystole, with increment in QTc from 525ms to 546ms, as noted with ECG. Consequently, hydroxychloroquine and azithromycin were stopped. Patient 3: A 77-year-old man was diagnosed with COVID-19, and he started receiving off label treatment with hydroxychloroquine 200mg twice daily and azithromycin 500mg on the first day followed by 250mg twice daily for 10 days. Subsequently, he developed isolated monomorphic ventricular extrasystole, with increment in QTc from 508ms to 560ms, as noted with ECG. Consequently, hydroxychloroquine and azithromycin were stopped. Patient 4: The male patient had paroxysmal atrial fibrillation, and he had been receiving flecainide and unspecified anticoagulant. Subsequently, he was hospitalised with COVID-19. At admission, he had sinus rhythm. He started receiving off label treatment with hydroxychloroquine 200mg twice daily and azithromycin 500mg on the first day followed by 250mg twice daily for 10 days. On day 2 of admission, the atrial fibrillation recurred with a long QT of 540ms as noted with ECG, while being on flecainide. Hydroxychloroquine and azithromycin were stopped and the sinus rhythm returned with normalisation of QT interval. Patient 5: A 77-year-old man had permanent atrial fibrillation, and had been receiving unspecified β-blocker and anticoagulant. He was then diagnosed with COVID-19. He started receiving off label treatment with hydroxychloroquine 200mg twice daily and azithromycin 500 mg on the first day followed by 250mg twice daily for 10 days. Subsequently, the atrial fibrillation recurred as noted with ECG. Eventually, the atrial fibrillation reduced, and the sinus rhythm was achieved. † The patient demographics for 4 patients (4 men aged 63, 65, 77 and 77 years, respectively) were obtained via direct communication with the Author. El Ouarradi A, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: