Affiliation:
1. Department of Cardiology Austin Hospital Melbourne Victoria Australia
2. Department of Cardiology Eastern Health Melbourne Victoria Australia
3. Eastern Health Clinical School Monash University Melbourne Victoria Australia
4. Emergency Medicine Program Eastern Health Melbourne Victoria Australia
5. Austin Health Clinical School University of Melbourne Melbourne Victoria Australia
Abstract
AbstractBackgroundIntravenous 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.MethodsRandomized 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 study‐defined rate control and rhythm control/reversion to sinus rhythm. The secondary endpoint was patient experienced side effects.ResultsOur 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.ConclusionsIV 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.
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine