Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department

Abstract

ImportanceWhether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown.ObjectiveTo assess potassium and magnesium administration and SCV probability in AF and AFL in the emergency department.Design, Setting, and ParticipantsA registry-based cohort study was conducted in the Department of Emergency Medicine of the Medical University of Vienna, Austria. All consecutive patients with AF or AFL were screened between February 6, 2009, and February 16, 2020.InterventionsIntravenous administration of potassium, 24 mEq, and magnesium, 145.8 mg.Main Outcomes and MeasuresThe primary outcome was the probability of SCV during the patient’s stay in the emergency department. Multivariable cluster-adjusted logistic regression was used to estimate the association between potassium and magnesium administration and the probability of SCV.ResultsA total of 2546 episodes of nonpermanent AF (median patient age, 68 [IQR, 58-75] years, 1411 [55.4%] men) and 573 episodes of nonpermanent AFL (median patient age, 68 [IQR, 58-75] years; 332 [57.9%] men) were observed. In AF episodes, intravenous potassium and magnesium administration vs no administration was associated with increased odds of SCV (19.2% vs 10.4%; odds ratio [OR], 1.98; 95% CI, 1.53-2.57). In AFL episodes, in contrast, no association was noted for the probability of SCV with potassium and magnesium vs no administration (13.0% vs 12.5%; OR, 1.05; 95% CI, 0.65-1.69).Conclusions and RelevanceThe findings of this registry-based cohort study on intravenous administration of potassium and magnesium suggest an increased probability of SCV in nonpermanent AF, but not AFL, during a patients’ stay in the emergency department.

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications—3 Years of a Single-Center Experience

“…The potential use of magnesium sulfate infusion in addition to the standard treatment of AF remains a subject of ongoing discussion, with multiple studies reporting its effectiveness despite its exclusion from the newest guidelines [ 20 ]. Furthermore, the intravenous administration of magnesium sulfate has been proposed to increase the likelihood of spontaneous conversion to sinus rhythm [ 21 ]. Its effectiveness in the prevention of AF and the lowering of the heart rate has been supported by the existing literature [ 22 , 23 , 24 ].…”

Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation

“…The partial explanation of the low efficacy of pharmacological cardioversion in AFl cohort in comparison to the AF group might be related with the much lower rate of IV potassium supplementation ( Table 2 ). Combined potassium and magnesium administration was associated with a higher rate of spontaneous return of sinus rhythm in AF, but not in the AFl population [ 22 ].…”

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

“…Therefore, close monitoring of serum potassium, magnesium and calcium levels is recommended in this group of patients. Even small deviations from the norm in terms of dyselectrolytemia should also be corrected, which allows for more effective prevention and treatment of, for instance, paroxysmal atrial fibrillation [28][29][30].…”