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Magnesium infusion and postoperative atrial fibrillation: a randomized clinical trial
Mahdi Najafi1, Reza Hamidian, Babak Haghighat
1Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. najafik@sina.tums.ac.ir
Insights
Prophylactic magnesium infusion may help prevent postoperative atrial fibrillation after coronary artery bypass grafting (CABG). However, its effectiveness may be reduced in diabetic patients.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Postoperative arrhythmias are common after cardiac surgery.
- Magnesium's role in preventing these arrhythmias is debated.
- The influence of diabetes mellitus on magnesium's prophylactic effect is unclear.
Purpose of the Study:
- To investigate if prophylactic magnesium administration prevents arrhythmias post-coronary artery bypass grafting (CABG).
- To assess the impact of diabetes mellitus on the efficacy of prophylactic magnesium.
Main Methods:
- A randomized clinical trial involving 345 CABG candidates.
- Patients received either magnesium infusion (study group) or no magnesium (control group).
- Arrhythmias were monitored using ECG; serum magnesium levels were measured at specified intervals.
Main Results:
- Atrial fibrillation (Af) occurred in 9.9% of patients.
- Higher serum magnesium levels were observed in the magnesium group (P < 0.001).
- Lower serum magnesium levels correlated with Af occurrence (P=0.02).
- Non-diabetic patients receiving magnesium had significantly lower Af incidence.
Conclusions:
- Atrial fibrillation occurrence is linked to serum magnesium levels.
- Diabetes mellitus appears to diminish the prophylactic benefit of magnesium in preventing Af.
Background:
Postoperative arrhythmias are among the most common complications of cardiac surgery. Total serum magnesium concentration will change after coronary bypass surgery but compensatory prophylactic administration of magnesium has remained a controversial issue. We studied whether prophylactic administration of magnesium could prevent post-coronary artery bypass grafting (CABG) arrhythmias and evaluated the effects of diabetes mellitus on prophylactic magnesium administration.
Methods:
In a clinical trial, 345 consecutive CABG candidates were randomly assigned to study (n = 166, 48.1%) and control groups. Patients in study group received supplemental magnesium infusion as following: 2 g [corrected] after induction of anesthesia until cardio-pulmonary bypass and then 8 g upon arrival in Intensive Care Unit (ICU) until 24 hr. Total serum magnesium concentration was measured at four designated time points: onset of induction, and 0, 24 and 48 hr after ICU admission. Cardiac arrhythmias were sought with a 12-lead electrocardiogram (ECG) from the end of surgery up till discharge.
Results:
Atrial Fibrillation (Af) occurred in 34 patients (9.9%). Total serum magnesium concentration was significantly higher in patients who received supplemental magnesium (P < 0.001) and significantly lower in Af patients (P= 0.02). Among non-diabetics, Af incidence was significantly lower in study group compared with control group.
Conclusions:
The occurrence of atrial fibrillation correlates with serum magnesium level. Diabetes mellitus probably hampers prophylactic effect of supplemental magnesium in preventing the occurrence of Af.
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