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The effect of magnesium versus verapamil on supraventricular arrhythmias
L Gullestad1, K Birkeland, P Mølstad
1Department of Internal Medicine, Baerum Hospital, Oslo, Norway.
Abstract:
Magnesium has previously been used in the treatment of various arrhythmias, but few randomized and prospective studies are available. In a single-blind study, the efficacy and safety of intravenous magnesium sulfate (bolus doses of 5 + 5 mmol followed by infusion of 0.04 mmol/min) versus verapamil (5 + 5 mg followed by 0.1 mg/min) was evaluated in 57 patients with supraventricular arrhythmias (supraventricular tachycardia, atrial fibrillation, and atrial flutter) of recent onset (less than 1 week). Fifteen (58%) of the patients receiving magnesium (n = 26) converted to sinus rhythm within 4 h, and 16 (62%) within 24 h. Verapamil caused a lower ventricular rate, but only six (19%) of the patients (n = 31) converted to sinus rhythm within 4 h (p < 0.01) and 16 (52%) within 24 h (NS). No side effects were observed during magnesium infusion, whereas six patients receiving verapamil had to be withdrawn from further study medication due to symptomatic side effects (hypotension in three, cardiac failure in three). Magnesium appears to be an effective and safe drug for the treatment of supraventricular arrhythmias. The overall efficacy for conversion to sinus rhythm is at least as effective as with verapamil, and its action is more rapid.
Insights
Intravenous magnesium sulfate effectively treats supraventricular arrhythmias, rapidly converting patients to sinus rhythm. This study found magnesium sulfate to be as effective and safer than verapamil for arrhythmia treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Magnesium sulfate is used for arrhythmias, but lacks robust clinical evidence.
- Limited randomized, prospective studies exist on magnesium's efficacy in supraventricular arrhythmias.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous magnesium sulfate versus verapamil.
- To compare conversion rates to sinus rhythm and side effect profiles in patients with recent-onset supraventricular arrhythmias.
Main Methods:
- A single-blind study involving 57 patients with supraventricular arrhythmias (tachycardia, atrial fibrillation, atrial flutter).
- Comparison of intravenous magnesium sulfate (bolus + infusion) against verapamil (bolus + infusion).
Main Results:
- Magnesium sulfate converted 58% to sinus rhythm within 4 hours and 62% within 24 hours.
- Verapamil converted only 19% within 4 hours (p < 0.01) and 52% within 24 hours.
- Magnesium sulfate had no observed side effects, while verapamil caused adverse events in 6 patients.
Conclusions:
- Intravenous magnesium sulfate is an effective and safe treatment for supraventricular arrhythmias.
- Magnesium sulfate demonstrates comparable or superior efficacy to verapamil for sinus rhythm conversion.
- Magnesium sulfate offers a faster onset of action compared to verapamil.