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In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ\/CQ use. Recently, however, the corrected QT interval (QTc)\u2013prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID\u201019 infection. This report was undertaken to summarize the current understanding of HCQ\/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus\u2010based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long\u2010term use of HCQ\/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk\u2013benefit assessments are important with regard to prescription of HCQ\/CQ. While cardiac toxicity related to HCQ\/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.<\/jats:p>","DOI":"10.1002\/art.41934","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T05:02:18Z","timestamp":1635224538000},"page":"2151-2160","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4803-3453","authenticated-orcid":false,"given":"Julianna","family":"Desmarais","sequence":"first","affiliation":[{"name":"Oregon Health &amp; Science University  Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8452-2441","authenticated-orcid":false,"given":"James T.","family":"Rosenbaum","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University and Legacy Devers Eye Institute  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8972-9388","authenticated-orcid":false,"given":"Karen H.","family":"Costenbader","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen M.","family":"Ginzler","sequence":"additional","affiliation":[{"name":"State University of New York Downstate Health Sciences University  Brooklyn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Fett","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University  Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1197-7864","authenticated-orcid":false,"given":"Susan","family":"Goodman","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery Weill Cornell Medicine  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"O\u2019Dell","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center and Omaha VA Hospital  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Pineau","sequence":"additional","affiliation":[{"name":"McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-5043","authenticated-orcid":false,"given":"Gabriela","family":"Schmajuk","sequence":"additional","affiliation":[{"name":"University of California San Francisco San Francisco VA Medical Center and Philip R. 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