<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2954-3835</journal-id>
<journal-title><![CDATA[Cardiovascular and metabolic science]]></journal-title>
<abbrev-journal-title><![CDATA[Cardiovasc. metab. sci]]></abbrev-journal-title>
<issn>2954-3835</issn>
<publisher>
<publisher-name><![CDATA[Asociación Nacional de Cardiólogos de México A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2954-38352021000100022</article-id>
<article-id pub-id-type="doi">10.35366/98227</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Early bradycardia in patients with COVID-19 and triple therapy]]></article-title>
<article-title xml:lang="es"><![CDATA[Bradicardia temprana en pacientes con COVID-19 y triple terapia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jacobo-Vargas]]></surname>
<given-names><![CDATA[Thalia Berenice]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Orozco-Gutiérrez]]></surname>
<given-names><![CDATA[Juan José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivero-Martínez]]></surname>
<given-names><![CDATA[Jesús Arturo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas Unidad en Farmacología ]]></institution>
<addr-line><![CDATA[CDMX ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas Servicio de Cardiología ]]></institution>
<addr-line><![CDATA[CDMX ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas Nephrology Division ]]></institution>
<addr-line><![CDATA[CDMX ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<volume>32</volume>
<numero>1</numero>
<fpage>22</fpage>
<lpage>31</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2954-38352021000100022&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2954-38352021000100022&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2954-38352021000100022&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Because there is still no effective medical treatment for COVID-19, off-label drugs have been used such as hydroxychloroquine or chloroquine, lopinavir/ritonavir and/or azithromycin, whose safety information is limited with the risk of developing potential cardiac adverse effects. In order to contribute with the safety information about combined drugs used in COVID-19, we used the CARE Guidelines: Consensus based Clinical Case Reporting Guideline Development by EQUATOR Network (Enhancing the Quality and Transparency of Health Research) to present four patients, without known cardiac pathology or evidence of cardiac rhythm disorders, who developed early sinus bradycardia, 1 to 3 days after the concomitant use of triple therapy with hydroxychloroquine, lopinavir/ritonavir and azithromycin, which solved after the suspension of one or more of the mentioned medications. These cases contribute to improving the awareness of safety concerns about the past use of off-label drugs for COVID-19. The risk of bradycardia with the triple therapy presented should be considered.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Debido a que aún no hay un tratamiento médico efectivo para la COVID-19, se han utilizado medicamentos fuera de indicación como la hidroxicloroquina o cloroquina, lopinavir/ritonavir y/o azitromicina, cuya información de seguridad es limitada con el riesgo de la presencia de efectos adversos cardiacos potenciales. Con la finalidad de contribuir con la información de seguridad del uso de combinación de medicamentos para COVID-19, seguimos la Guía «Consensus based Clinical Case Reporting Guideline Development» desarrollada por la Red EQUATOR (Enhancing the Quality and Transparency of Health Research) para presentar cuatro pacientes, sin patología cardiaca conocida o evidencia de trastornos del ritmo cardiaco, que desarrollaron bradicardia sinusal temprana uno a tres días posteriores al uso concomitante de la triple terapia con hidroxicloroquina, lopinavir/ritonavir y azitromicina, la cual remitió tras la suspensión de uno o más de los medicamentos mencionados. Estos casos contribuyen a mejorar el conocimiento de los problemas de seguridad sobre el uso pasado de medicamentos no aprobados para la COVID-19. Se debe considerar el riesgo de bradicardia con la triple terapia presentada.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Bradycardia]]></kwd>
<kwd lng="en"><![CDATA[COVID-19]]></kwd>
<kwd lng="en"><![CDATA[hydroxychloroquine]]></kwd>
<kwd lng="en"><![CDATA[azithromycin]]></kwd>
<kwd lng="en"><![CDATA[lopinavir-ritonavir drug combination]]></kwd>
<kwd lng="es"><![CDATA[Bradicardia]]></kwd>
<kwd lng="es"><![CDATA[COVID-19]]></kwd>
<kwd lng="es"><![CDATA[hidroxicloroquina]]></kwd>
<kwd lng="es"><![CDATA[azitromicina]]></kwd>
<kwd lng="es"><![CDATA[combinación de fármacos lopinavir/ritonavir]]></kwd>
</kwd-group>
</article-meta>
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