MAGNESIUM SULFATE: AN ADJUNCTIVE THERAPY IN THE FIRST HOUR OF MANAGEMENT OF RAPID ATRIAL FIBRILLATION IN EMERGENCY DEPARTMENT

##plugins.themes.academic_pro.article.main##

Khedija Zaouche
Hadil Mhadhbi
Radhia Boubaker
Ramla Baccouche
Insaf Khattech
Kamel Majed

Abstract

Introduction: Rapid Atrial fibrillation (AF) is a common arrhythmia in emergency department (ED) that requires an urgent control of ventricular rate.
Aim: To evaluate the safety and efficiency of magnesium sulfate as an adjunctive therapy in addition to usual care for rapid AF in emergency department.   
Methods: This was a prospective, randomized, double-blind study. We included patients who presented to ED with rapid AF >110 batt/min. Group A received 3g of magnesium in 100mL of glucose solution and group B received 100 ml of glucose solution. Primary endpoint was slowing the ventricular rates to less than 110 beats/ min in the first 12 hours of management.   
Results: One hundred and three patients were included. Fifty-three patients in group A with a mean heart rate of 146 ± 18 beats / min and fifty patients in group B with a mean heart rate of 143 ± 17 beats / min. A significantly greater number of patients slowed down their ventricular rate in group A during the first hour of management (p = 0.02). After 12 hours, mean heart rate was significantly lower in group A (p = 0.04).
Conclusion: The use of 3 g of magnesium sulfate slowed down the ventricular rate of a larger number of patients with rapid AF in the first hour of management. Only minor adverse effects were registered.

Keywords:

Atrial fibrillation, Heart rate, Magnesium sulfate, Emergency Department

##plugins.themes.academic_pro.article.details##

References

  1. REFERENCES 1. January CT, Wann LS, Alpert JS,Calkins H, Cigarroa JE, Cleveland JC et al. 2014 AHA/ACC/HRS guidelines for the management of patients with atrial fibrillation Task Force on Practice Guidelines and te Heart Rhythm Society. Circulation. 2014;130:2071-104. 2. Alan S, Elaine M, Kathleen A, YuChiao C, Lori E, Joe V, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults. JAMA. 2001;285:2370-5. 3. Taboulet P, Duchenne J, Lefort H, Zanker C, Jabre P, Davy JM, et al. Prise en charge de la fibrillation atriale en médecine d'urgence. Recommandation de la Société française de médecine d'urgence en partenariat avec la Société française de cardioogie. Ann Fr Med Urgences. 2015;5:260-79. 4. Direction de la Pharmacie et du Médicament. FORMULAIRE THERAPEUTIQUE TUNISIEN: 2ème Edition. 5. Miller S, Crystal E, Garfinkle M, Lau C, Lashevsky I, Connolly SJ. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis. Heart. 2005;9(5):618-23. 6. Toraman F, Karabulut H, Alhan HC, Dagdelen S, Tarcan S. Magnesium Infusion Dramatically Decreases the Incidence of Atrial Fibrillation After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2001;72(4):1256-62. 7. Gullestad L, Birkeland K, Molstad P, Hayer MM, Vanberg P, Kiekshus J. The effect of magnesium versus verapamil on supraventricular arrhythmias. Clin Cardiol. 1993;16:429-34. 8. Chiladakis JA, Stathopoulos C, Davlouros P, Manolis AS. Intravenous magnesium sulfate versus diltiazem in paroxysmal atrial fibrillation. Int J Cardiol. 2001;79:287-91. 9. Davey MJ, Teubner D. A Randomized Controlled Trial of Magnesium Sulfate, in Addition to Usual Care, for Rate Control in Atrial Fibrillation. Ann of Emerg Med. 2005;45(4):347-53 10. Christiansen E. Dose-related cardiac electrophysiological effects of intravenous magnesium. A double-blind placebo-controlled dose-response study in patients with paroxysmal supraventricular tachycardia. Europace. 2000; 2(4):320â€6. 11. Bouida W, Beltaief K, Msolli MA, Azaiez N, Ben Soltane H, Sekma A, et al. Lowâ€dose magnesium sulfate versus high dose in the early management of rapid atrial fibrillation: randomized controlled doubleâ€blind study (LOMAGHI Study). AcadEmerg Med. 2019; 26(2):183-91. 12. Onalan O, Crystal E, Daoulah A, Lau C, Crystal A, Lashevsky A. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol. 2007;99:1726-32. 13. Ho KM, Sheridan DJ, Paterson T. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Hear. 2007;93:1433-40. 14. Boschat J, Gilard M, Etienne Y, Roziz R, Jobic Y, Penther P, et al. Hemodynamic effects of intravenous magnesium sulfate in man. Arch Mal Coeur Vaiss. 1989;82:361-4. 15. Schechter M, Resenblatt S, Motro M, Rabinowitz B, Kapinsky E, Arganat O. Magnesium for Reduction of Pulmonary Artery Pressure in Primary Pulmonary Hypertension. Magnesium-Bulletin. 1995;4:115-6. 16. Chandran S, Haqueb ME, Wickramasinghe H, Wint Z. Use of magnesium sulphate in severe persistent pulmonary hypertension of the newborn. J Trop Pediatr. 2004;50(4):219-23. 17. Frick M, Stergren JO, Rosenqvist M. Effect of Intravenous Magnesium on Heart Rate and Heart Rate Variability in Patients With Chronic Atrial Fibrillation. Am J Cardiol. 1999;84:104-8. 18. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386:154-62. 19. Kotecha D, Piccini JP. Atrial fibrillation in heart failure: what should we do? Eur Heart J. 2015;36:3250-7. 20. Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail. 2009;11:676-83. 21. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA , et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107:2920-5. 22. Van Gelder IC, Groenveld HF, Crijns HM, Tuininga YS, Tijssen JP, Alings AM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010;362(15):1363â€73.