Utility of magnesium sulfate in the treatment of rapid atrial fibrillation in the emergency department: a systematic review and meta-analysis
- 2 May 2022
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in European Journal of Emergency Medicine
- Vol. 29 (4), 253-261
- https://doi.org/10.1097/mej.0000000000000941
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; I2 = 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.Keywords
This publication has 38 references indexed in Scilit:
- Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgeryEmergencias, 2013
- Systemic Magnesium to Reduce Postoperative Arrhythmias After Coronary Artery Bypass Graft Surgery: A Meta-Analysis of Randomized Controlled TrialsJournal of Cardiothoracic and Vascular Anesthesia, 2012
- Does the prophylactic administration of magnesium sulphate to patients undergoing thoracotomy prevent postoperative supraventricular arrhythmias? A randomized controlled trialBritish Journal of Anaesthesia, 2011
- Magnesium sulphate and amiodarone prophylaxis for prevention of postoperative arrhythmia in coronary by-pass operationsJournal of Cardiothoracic Surgery, 2009
- An Evaluation of the Impact of Oral Magnesium Lactate on the Corrected QT Interval of Patients Receiving Sotalol or Dofetilide to Prevent Atrial or Ventricular Tachyarrhythmia RecurrenceAnnals of Noninvasive Electrocardiology, 2006
- A Randomized Controlled Trial of Magnesium Sulfate, in Addition to Usual Care, for Rate Control in Atrial FibrillationAnnals of Emergency Medicine, 2005
- Acute Effects of Intravenous Magnesium on Ventricular Refractoriness and Monophasic Action Potential Duration in HumansScandinavian Cardiovascular Journal, 1999
- Magnesium abolishes inadequate kinetics of frequency adaptation of the Q-aT interval in the presence of sotalolCardiovascular Research, 1997
- Effect of Magnesium Sulfate on Ventricular Rate Control in Atrial FibrillationAnnals of Emergency Medicine, 1994
- Depressant effect of magnesium on early afterdepolarizations and triggered activity induced by cesium, quinidine, and 4-aminopyridine in canine cardiac Purkinje fibersAmerican Heart Journal, 1989