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Systemic magnesium to reduce postoperative arrhythmias after coronary artery bypass graft surgery: a meta-analysis of
Gildasio S De Oliveira1, Jennifer S Knautz, Saadia Sherwani
1Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. g-jr@northwestern.edu
Insights
Systemic magnesium sulfate may reduce supraventricular arrhythmias after heart surgery, but this effect was mainly seen in lower-quality studies. Magnesium did not prevent other complications or shorten hospital stays.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Postoperative cardiac arrhythmias are a common complication after coronary artery bypass graft (CABG) surgery.
- Systemic magnesium administration has been investigated as a potential prophylactic measure.
Purpose of the Study:
- To evaluate the efficacy of systemic magnesium in preventing postoperative cardiac arrhythmias in patients undergoing CABG surgery.
Main Methods:
- A meta-analysis of randomized controlled trials was conducted.
- Included studies involved patients undergoing CABG surgery who received systemic perioperative magnesium sulfate.
- Twenty studies with 3,696 subjects were analyzed.
Main Results:
- Systemic magnesium showed a trend towards reducing supraventricular arrhythmias (OR = 0.69; 95% CI, 0.53-0.90).
- This effect was significant in lower-quality studies but not in higher-quality studies.
- Magnesium did not significantly impact the incidence of stroke, myocardial infarction, death, or hospital/ICU length of stay.
Conclusions:
- The observed benefit of magnesium in preventing supraventricular arrhythmias is questionable due to study quality variations.
- Magnesium sulfate did not reduce associated complications or improve resource utilization.
- Alternative strategies are needed for effective arrhythmia prevention in this patient population.
Objective:
To evaluate the effect of systemic magnesium on the prevention of postoperative cardiac arrhythmias after coronary artery bypass graft surgery.
Design:
A meta-analysis.
Setting:
Randomized controlled trials evaluating the effect of systemic magnesium on the incidence of postoperative arrhythmias.
Participants:
Patients undergoing coronary artery bypass graft surgery.
Interventions:
Systemic perioperative administration of magnesium sulfate.
Measurements And Main Results:
Twenty studies evaluating 3,696 subjects were included. The combined effect suggested that systemic magnesium reduced the incidence of supraventricular arrhythmias compared with saline (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.53-0.90; number needed to treat [NNT] = 14). The effect was present for lower-quality studies (Jadad score ≤3; OR = 0.47; 95% CI, 0.28-0.81; NNT = 8), but it was not detected for higher-quality studies (Jadad >3; OR = 0.85; 95% CI, 0.66-1.11). There was no association between the total dose of magnesium administration and the incidence of supraventricular arrhythmias (p = 0.19). There was no effect of magnesium on the incidence of postoperative stroke, myocardial infarction, and death. In addition, magnesium did not reduce the hospital or intensive care unit lengths of stay (all p > 0.05).
Conclusions:
The effect of magnesium sulfate in reducing postoperative supraventricular arrhythmias was significant when examined by lower-quality studies but not when examined by higher-quality studies. This fact probably is responsible for controversial findings reported in the literature. Also, magnesium sulfate did not reduce the incidence of complications associated with the development of postoperative cardiac arrhythmias. More effective strategies should be used to prevent complications caused by arrhythmias in this patient population.
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