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Arrhythmia prophylaxis after coronary artery surgery. A randomised controlled trial of intravenous magnesium chloride
I W Colquhoun1, G A Berg, M el-Fiky
1University Department of Cardiac Surgery, Glasgow Royal Infirmary, UK.
Insights
Intravenous magnesium supplements significantly reduced supraventricular arrhythmias after coronary artery surgery. This finding offers a new therapeutic avenue for improving patient outcomes post-cardiac procedures.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Supraventricular arrhythmias are a common complication following coronary artery surgery.
- Electrolyte imbalances, particularly magnesium deficiency, may contribute to postoperative arrhythmias.
- Optimizing magnesium levels could potentially mitigate these cardiac events.
Purpose of the Study:
- To investigate the efficacy of intravenous magnesium supplementation in reducing the incidence of supraventricular arrhythmias post-myocardial revascularisation.
- To assess the impact of magnesium infusion on serum magnesium concentrations in the early postoperative period.
Main Methods:
- A randomized controlled trial involving 130 patients undergoing elective myocardial revascularisation.
- Patients received either an intravenous infusion of 50 mmol magnesium chloride or a placebo for the first 48 hours post-surgery.
- Postoperative serum magnesium levels and the incidence of arrhythmias were monitored.
Main Results:
- Magnesium group (n=66) showed elevated serum magnesium levels (0.82 to 1.2 mmol/l), while placebo group (n=64) showed decreased levels (0.83 to 0.79 mmol/l).
- The incidence of supraventricular arrhythmias was significantly lower in the magnesium group (16.7%) compared to the placebo group (37.5%) (P = 0.013).
- Ventricular fibrillation and frequent ventricular ectopics were observed, with one death in the magnesium group due to perioperative myocardial infarction.
Conclusions:
- Intravenous magnesium supplementation is effective in reducing the incidence of supraventricular arrhythmias after coronary artery surgery.
- Maintaining adequate serum magnesium levels appears crucial for preventing postoperative cardiac complications.
- Further research is warranted to explore the optimal dosage and long-term benefits of magnesium therapy in cardiac surgery patients.
Abstract:
One hundred and thirty patients undergoing elective myocardial revascularisation were randomised to receive an intravenous infusion containing either 50 mmol magnesium chloride or placebo during the first 48 h following surgery. Magnesium was given to 66 patients and a placebo infusion to 64 patients. Postoperative serum magnesium concentrations fell in the placebo group (from 0.83 +/- 0.06 to 0.79 +/- 0.11 mmol/l) but were elevated in the magnesium group (from 0.82 +/- 0.05 to 1.2 +/- 0.25 mmol/l). In total, 35 patients (26.9%) had a supraventricular arrhythmia, of which 11 were in the magnesium group (16.7%) and 24 (37.5%) in the placebo group (P = 0.013). Three patients in the magnesium group had an episode of ventricular fibrillation and three patients in the placebo group had frequent ventricular ectopics. There was one death in the magnesium group associated with a perioperative myocardial infarction. This study shows that intravenous magnesium supplements reduce the incidence of supraventricular arrhythmias following coronary artery surgery.