Magnesium Adjunctive Therapy in Atrial Arrhythmias

Ganga, Harsha V.; Noyes, Adam; White, C Michael; Kluger, Jeffrey

doi:10.1111/pace.12189

Cited by 19 publications

(15 citation statements)

References 84 publications

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“…Previous studies have shown a benefit of Mg in patients with AF by increasing the success of pharmacological cardioversion and by decreasing the incidence of postoperative AF. 8,9,22,23 Facilitation of cardioversion by Mg has been studied more commonly in pharmacological cardioversion, in which Mg also has the benefit of decreasing adverse events, such as torsades de pointes. 8,9 However, there is a paucity of data on the role of Mg alone in facilitating electric cardioversion.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous Magnesium in Facilitating Cardioversion of Atrial Fibrillation

Rajagopalan

Shah

Narasimha

et al. 2016

Circ: Arrhythmia and Electrophysiology

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P atients with atrial fibrillation (AF) may require electric cardioversion, either because of intolerable symptoms related to AF or as part of a rhythm control strategy. See Editorial by KotechaElectric cardioversion using a biphasic waveform has a procedural success rate of 86% to 94%, sometimes requiring multiple shocks.1-3 The success of electric cardioversion depends on the duration of AF, transthoracic impedance, delivered energy, and the type of electric shock used.1 Pharmacological cardioversion using antiarrhythmic drugs (AADs) has a lower success rate and may take a few hours to days to achieve sinus rhythm.Magnesium (Mg) is an abundant mineral in the body, present in bone, the heart, and the central nervous system. In the heart, Mg modulates potassium (slow-activating delayed rectifier K channel, I Ks ) and calcium channels (L-type) in both the atria and the ventricles. 4,5 Mg has been shown to have membrane-stabilizing properties within the atrium. 4 This membrane-stabilizing property may be particularly helpful in rhythm control of AF. Data from the Framingham offspring and Atherosclerosis Risk in Communities (ARIC) prospective cohorts have linked low serum Mg levels to AF. 6,7 Studies on pharmacological cardioversion have shown increased success of cardioversion when Mg is used along with an AAD. 8,9 A recent study on electric cardioversion showed that the infusion of a K-Mg electrolyte solution was successful in facilitating electric cardioversion of AF.3 On the basis of data suggesting an association of low Mg levels with the incidence of AF and the membrane-stabilizing property of Mg in the atrium with the modulation of I K+ and I Ca2+ currents, we postulated that administration of Mg alone would be useful in increasing the success of cardioversion. The purpose of this study was to investigate the benefit of intravenous © 2016 American Heart Association, Inc. Circ Arrhythm Electrophysiol

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Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous Magnesium in Facilitating Cardioversion of Atrial Fibrillation

Rajagopalan

Shah

Narasimha

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…На сегодняшний день исследования [6][7][8] убедительно свидетельствуют о значимой роли гипомагниемии в увеличении риска развития и рецидивирования фибрилляции предсердий (ФП). При этом именно пациентам аритмологического профиля нередко длительно назначают ИПП для снижения риска возникновения желудочно-кишечных кровотечений на фоне антикоагулянтной терапии, а также для лечения сопутствующих эрозивно-язвенных поражений желудка и двенадцатиперстной кишки, которые способствуют прогрессированию нарушений сердечного ритма парасимпатического генеза.…”

Section: Hypomagnesemia Induced By Proton Pump Inhibitors In Af ингибunclassified

Study of the Effect of Proton Pump Inhibitors on the Development of Hypomagnesemia in Patients with Paroxysmal Atrial Fibrillation on the Background of Autonomic Sinus Node Dysfunction

Bozhko

Архипов

Belokonova

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study the effect of proton pump inhibitors (PPIs) on the development of hypomagnesemia in patients with paroxysmal atrial fibrillation (AF) on the background of autonomic sinus node dysfunction (ASND).Material and methods. A prospective cohort study included 32 patients with an established diagnosis of ASND and often recurrent paroxysmal AF. The main group consisted of 17 patients who took pantoprazole at a dose of 20 mg 2 times a day as treatment of diagnosed duodenal erosions within 6 weeks from the time of the initial visit to an arrhythmologist. The remaining 15 patients did not take PPIs and were included in the control group. The determination of magnesium in whole blood, plasma and formed elements was carried out twice in all patients – at the initial visit and after 6 weeks. In addition, in the experiment, complex-forming activity of solutions of various PPIs (esomeprazole, pantoprazole, rabeprazole and omeprazole) with respect to magnesium ions was studied. The author’s method was used, based on turbidimitric determination of the light transmission during the heterogeneous reaction of the formation of magnesium phosphates in the presence of the analyzed drug or without it.Results. There were no significant differences in the magnesium content in the blood of patients of the main and control groups before taking PPIs. After taking of pantoprazole by the patients of the main group there were significant differences between main and control groups in magnesium in whole blood (0.48 [0.44-0.51] mmol/l vs 0.55 [0.5-0.61] mmol/l, p=0.01) and its values in formed elements (0.52 [0.45-0.67] mmol/l vs 0.75 [0.65-1.2] mmol/l, p=0.009). Analysis of magnesium content in patients of the main group before and after taking of pantoprazole also showed a significant decrease in intracellular concentrations of the element (0.6 [0.51-1.0] mmol/l vs 0.52 [0.45-0.67] mmol/l, p=0.002), as well as decrease in its total content in whole blood (0.51 [0.45-0.59] mmol/l vs 0.48 [0.44-0.51] mmol/l, p=0.04). To substantiate the observed effects it was experimentally proved the possibility of formation of strong complex compounds between the ions of magnesium and PPIs: the highest activity was demonstrated by rabeprazole and pantoprazole (coefficients of complex formation per unit of total organic carbon – 1.5 and 0.72, respectively) and the lowest – omeprazole and esomeprazole (0.04 and 0.09, respectively).Conclusion. A decrease of magnesium content in whole blood and formed elements in patients with paroxysmal AF on the background of ADSN was mediated by a six-week intake of pantoprazole in a dose of 20 mg 2 times a day for the treatment of concomitant erosion of the duodenum. When choosing PPIs for arrhythmological patients with concomitant gastro-duodenal pathology, it is advisable to be guided by the complexing activity of drugs with respect to magnesium ions: the most pronounced metal-ligand interaction with magnesium was shown by rabeprazole and pantoprazole, and the least – omeprazole and esomeprazole.

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“…Magnesium's effect on heart rhythm is most likely secondary to its physiological function by inhibiting calcium channels in the atrioventricular (AV) node, which serves as the midway point of the cardiac conduction pathway, whereas hypomagnesemia decreases potassium levels in cardiac muscle intracellularly, which can result in arrhythmia [27]. A significant number of patients with arrhythmias have decreased serum magnesium levels [28]. Gobbo et al conducted a study of 750 diabetic adult participants to evaluate an association, if any exists, between serum magnesium levels and the presence of premature ventricular complex (PVC) on Holter monitoring.…”

Section: Arrhythmiasmentioning

confidence: 99%

Dietary Magnesium Intake and Heart Health

Carpenter¹,

Zehra²,

Fatmi³

2018

Calcified Constrictive Pericarditis Treated With Ultrasonic Devices

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With magnesium being the second most common intracellular cation in the human body and the presence of hypomagnesemia in 10% of hospital admissions, magnesium deficiency has become a clinically significant nutritional deficiency in context of heart health. Magnesium has long been used as a treatment modality for cardiac arrhythmias as serum magnesium concentration of 1.44 mEq/L to 1.8 mEq/L has been found to have a statistically significant inverse association with cardiovascular disease events. Patients with the highest intake of magnesium were found to have incidents of sudden cardiac death reduced by 77% while hypomagnesemia is found to be associated with increased risk of congestive heart failure and cardiac arrhythmias. It has also been demonstrated that high dietary intake of serum magnesium is associated with decrease in systolic and diastolic blood pressure secondary to reduction in vascular tone and an increase in vasodilatory substances, like Prostaglandin E. Association of cardiovascular diseases with hypomagnesemia and the need for the fulfilment of RDA goals, authenticates the use of oral magnesium supplements, with established safety profile and lack of potential for toxicity.

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Magnesium Adjunctive Therapy in Atrial Arrhythmias

Cited by 19 publications

References 84 publications

Efficacy of Intravenous Magnesium in Facilitating Cardioversion of Atrial Fibrillation

Efficacy of Intravenous Magnesium in Facilitating Cardioversion of Atrial Fibrillation

Study of the Effect of Proton Pump Inhibitors on the Development of Hypomagnesemia in Patients with Paroxysmal Atrial Fibrillation on the Background of Autonomic Sinus Node Dysfunction

Dietary Magnesium Intake and Heart Health

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