Magnesium in the Management of Atrial Fibrillation With Rapid Ventricular Response

Nogic, Jason; MacPherson, Michael; Aldridge, Emogene; Sajeev, J.; Roberts, L.; Lowman, David; Sze, Serena; Kwong, Alex S. F.; Buntine, Paul; Teh, A.

doi:10.1016/j.jacep.2022.01.017

Cited by 1 publication

(10 citation statements)

References 3 publications

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“…This metaanalysis included 9 RCTs, with two recently published papers substantially increasing the cohort size compared to previous metaanalyses. 11,12,20 Our results show that IV Mg increased the likelihood of successfully achieving study-defined rate control and reversion to sinus rhythm in patients presenting with AF with RVR in addition to standard of care. Additionally, IV Mg has an acceptable side effect profile with flushing being the most reported side effect in those receiving magnesium.…”

Section: Discussionmentioning

confidence: 70%

“…Of the 76 studies returned in the search results, 9 studies were included in the final analysis as shown in Figure 1. [11][12][13][14][15][16][17][18][19] All studies except one were published in the English language. 11 | 1287 one study was triple-blinded, seven were double-blinded and in one study the details of blinding were unknown.…”

Section: Resultsmentioning

confidence: 99%

“…In a recently published RCT by our group, the use of IV Mg in a contemporary cohort of patients found no additional benefit in achieving rate or rhythm control compared to the standard of care. 12 In contrast, other studies have found IV Mg effective in rate control early in the care of patients with AF RVR. 11,13 We, therefore, sought to perform a meta-analysis on placebocontrolled, randomized clinical trials conducted in patients with nonpostoperative AF with RVR examining the efficacy of IV Mg in addition to study-defined standard of care for both rate and rhythm control.…”

Section: Introductionmentioning

confidence: 93%

“…Only two studies described whether patients had a history of chronic AF 12,13 and one study excluded patients with known or chronic AF. 14 Studies involving more selected patient cohorts are required to evaluate whether more specific subgroups of patients may be more or less likely to benefit from IV Mg therapy.…”

Section: Limitationsmentioning

confidence: 99%

“…8 Nevertheless, a limited number of previous clinical trials have shown conflicting or inconclusive results. 9,10 Recently, further randomized control trials (RCTs) have been published 11,12 increasing the patient cohort by 29% and utilizing more contemporary medical therapy.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Efficacy of intravenous magnesium for the management of non‐post operative atrial fibrillation with rapid ventricular response: A systematic review and meta‐analysis

Enayati

Gin

Sajeev

et al. 2023

Cardiovasc electrophysiol

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Background: Intravenous magnesium (IV Mg), a commonly utilized therapeutic agent in the management of atrial fibrillation (AF) with rapid ventricular response, is thought to exert its influence via its effect on cellular automaticity and prolongation of atrial and atrioventricular nodal refractoriness thus reducing ventricular rate. We sought to undertake a systematic review and meta-analysis of the effectiveness of IV Mg versus placebo in addition to standard pharmacotherapy in the rate and rhythm control of AF in the nonpostoperative patient cohort given that randomized control trials (RCTs) have shown conflicting results.Methods: Randomized controlled trials comparing IV Mg versus placebo in addition to standard of care were identified via electronic database searches. Nine RCTs were returned with a total of 1048 patients. Primary efficacy endpoints were studydefined rate control and rhythm control/reversion to sinus rhythm. The secondary endpoint was patient experienced side effects.Results: Our analysis found IV Mg in addition to standard care was successful in achieving rate control (odd ratio [OR] 1.87, 95% confidence interval [CI] 1.13−3.11, p = .02) and rhythm control (OR 1.45, 95% CI 1.04−2.03, p = .03). Although not well reported among studies, there was no significant difference between groups regarding the likelihood of experiencing side effects.Conclusions: IV Mg, in addition to standard-of-care pharmacotherapy, increases the rates of successful rate and rhythm control in nonpostoperative patients with AF with rapid ventricular response and is well tolerated.

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Section: Discussionmentioning

confidence: 70%