Effects of proton pump inhibitors and electrolyte disturbances on arrhythmias

Abstract

Several case reports have been written regarding the relationship between the use of proton pump inhibitors (PPI) and hypomagnesemia. Some of these reported cases have electrocardiogram abnormalities where electrolytes deficiencies were the contributing factor for these events. This study investigates the correlation between different arrhythmias and the use of PPI and hypomagnesaemia incidence. Four-hundred and twenty-one patients admitted to the critical care unit with unstable angina, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction were included in this study. One-hundred and eighty-four patients (43.8%) received PPI and 237 patients (51.16%) did not, magnesium levels were low (<1.8 mg/dL) in 95 patients (22.5%), and 167 patients (39.6%) developed arrhythmias. The P-values for the regression coefficient association for the use of PPI and the level of magnesium were P = 1.31e−29 and P = 8e−102, respectively. The P-values indicate that there is a statistically significant association between the PPI use, magnesium levels, and the occurrence of cardiovascular events, with a strong correlation factor of 0.817. Patients receiving PPIs should be followed closely for magnesium deficiency, especially if they experience acute cardiovascular events, because this may contribute to worsening arrhythmias and further complications.

The Association between the Use of Proton Pump Inhibitors and the Risk of Hypomagnesemia: A Systematic Review and Meta-Analysis

“…The cut-off value of serum magnesium level for defining hypomagnesemia was 1.6, 1.7, and 1.8 mg/dL in one [25] , five [22] , [24] , [26] , [28] , [29] , and three studies [23] , [27] , [30] , respectively ( Table 2 ). Among patients taking PPIs, the median proportion of patients with hypomagnesemia in all included studies was 27.1% (range, 11.3–55.2%).…”

“…Although many case reports have described patients with PPI-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified in comparative studies [22] – [30] . In some studies, the association between PPI use and hypomagnesemia was not identified [23] – [25] , [29] , while in others, PPI use was found to increase the risk of hypomagnesemia [22] , [26] – [28] , [30] . The discrepancy between these studies may be attributed to various patient characteristics, and/or underlying conditions.…”

Proarrhythmic and Torsadogenic Effects of Potassium Channel Blockers in Patients

“…Recently, there has been some controversy regarding the arrhythmic risk of proton-pump inhibitor (PPI)-related hypomagnesemia. It is currently unknown whether PPIs contribute to TdP risk in patients with gastrointestinal disease and electrolyte disturbances (59–61). As the mechanism of this observation is currently unknown, further translational studies and controlled prospective trials will be necessary to determine the contribution of PPIs towards TdP risk.…”

Proton pump inhibitors and hypomagnesemia monitoring

“…I thank El-Charabaty et al1 for their interesting paper which concludes that patients in receipt of proton pump inhibitors (PPIs) need to be followed closely for magnesium deficiency, particularly in the face of acute cardiovascular events, as this may worsen arrhythmias and hence increase the likelihood of complications. I would of course reference Faulheber et al’s recent paper that highlights the fact that hypomagnesemia in PPI use is uncommon2 – but of course, uncommon does not mean never, and as such the former’s conclusion is sound advice to all juniors and seniors alike.…”

“…El-Charabaty et al’s transparency regarding limitations was exemplary, particularly their acknowledgment of the observational status of the study 1. It would be interesting to see the results in a study drawn from an outpatient setting, as close monitoring in that domain could significantly add to the workload of primary care physicians.…”