Utility of magnesium sulfate in the treatment of rapid atrial fibrillation in the emergency department: a systematic review and meta-analysis

Abstract

Atrial fibrillation with rapid ventricular response (Afib/ RVR) is a frequent reason for emergency department (ED) visits and can be treated with a variety of pharmacological agents. Magnesium sulfate has been used to prevent and treat postoperative Afib/RVR. We performed a systematic review and meta-analysis to assess the effectiveness of magnesium for treatment of Afib/RVR in the ED. PubMed and Scopus databases were searched up to June 2021 to identify any relevant randomized trials or observational studies. We used Cochrane's Risk-of-Bias tools to assess study qualities and random-effects meta-analysis for the difference of heart rate (HR) before and after treatment. Our search identified 395 studies; after reviewing 11 full texts, we included five randomized trials in our analysis. There were 815 patients with Afib/RVR; 487 patients (60%) received magnesium treatment, whereas 328 (40%) patients received control treatment. Magnesium treatment was associated with significant reduction in HR [standardized mean difference (SMD), 0.34; 95% CI, 0.21-0.47; P < 0.001; I 2 = 4%), but not associated with higher rates of sinus conversion (OR, 1.46; 95% CI, 0.726-2.94; P = 0.29), nor higher rates of hypotension and bradycardia (OR, 2.2; 95% CI, 0.62-8.09; P = 0.22). Meta-regressions demonstrated that higher maintenance dose (corr. coeff, 0.17; P = 0.01) was positively correlated with HR reductions, respectively. We observed that magnesium infusion can be an effective rate control treatment for patients who presented to the ED with Afib/RVR. Further studies with more standardized forms of control and magnesium dosages are necessary to assess the benefit/risk ratio of magnesium treatment, besides to confirm our observations.

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

“…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]. In our emergency department, magnesium was administered as an adjunctive treatment by physicians.…”

Magnesium Sulfate and Its Versatility in Anesthesia: A Comprehensive Review

“…Flushing, headaches, perspiration and fever, nausea, vomiting, impaired vision, and soreness at the injection site or intramuscular site are a few of the less typical minor adverse effects. A greater frequency of mild side effects, such as flushing, tachycardia, hypotension, nausea, vomiting, sweating, and injection site issues [49][50][51].…”

Clinical Effects and Functional State of the Endothelium in Patients with Arterial Hypertension with a Suboptimal Level of K+ in the Dynamics of Treatment with a Potassium-Magnesium Mineral Complex

“…Наслідком «калій-магнієвого дефіциту» в клінічній практиці досить часто стають порушення серцевого ритму. Доведено, що зменшення рівня Мg 2+ та К + може знижувати активність Na + /K + -АТФази, скорочувати потенціал дії, порушувати процеси реполяризації та рефрактерний період кардіоміоцитів, що призводить до збільшення ризику шлуночкових аритмій і раптової серцевої смерті [10][11][12][13][14][15].…”