Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting

Fanning, William J.; Thomas, Chantal; Roach, Albert C.; Tomichek, Richard C.; Alford, William C.; Stoney, William S.

doi:10.1016/0003-4975(91)90918-g

Cited by 170 publications

(63 citation statements)

References 21 publications

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“…Hypomagnesemia observed on 1 st POD is a relevant symptom preceding atrial fibrillation. [13] Hypomagnesemia is known to cause muscle weakness and respiratory failure. It is one factor causing difficulty in weaning the patient from ventilator.…”

Section: Discussionmentioning

confidence: 99%

Serum Magnesium Levels in Off - Pump Coronary Artery Bypass Grafting

Manne¹,

Ravisekhar²

2015

jemds

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ABSTRACT:Magnesium plays an essential role in cardiac protection. Magnesium has many beneficial effects like it improves contractility and reduces the number of cardiac arrhythmia episodes. The aim of the study was to analyze the magnesium concentration in patients undergoing off-pump CABG. The study included 110 patients who underwent general anesthesia and coronary artery bypass graft. Magnesium level was 2.0mg/dl at baseline, 2.18 mg/dl, 2.02 mg/dl and 1.94 mg/dl respectively on 3 consecutive days post-operatively. The lowering of magnesium recommends routine serum magnesium determination to prevent complications.

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Section: Discussionmentioning

confidence: 99%

Serum Magnesium Levels in Off - Pump Coronary Artery Bypass Grafting

Manne¹,

Ravisekhar²

2015

jemds

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“…10 -19 It is also attractive from a theoretical standpoint, because serum Mg levels have been shown to decline after cardiopulmonary bypass and do not recover to preoperative levels until 3 to 5 days after surgery, which coincides with the period during which most cases of AF develop. 11 Many small, randomized trials of MgSO 4 for prevention of AF have been published, and a recent meta-analysis concluded that MgSO 4 is an effective prophylactic agent for prevention of postoperative AF, 20 with the European Association for Cardiothoracic Surgery recommending prophylactic administration of IV MgSO 4 for prevention of postoperative AF in their recently published guidelines. 21 Regardless, we believe that there is still clinical equipoise regarding its routine use because the evidence comes from multiple small, underpowered trials, with conflicting results, probably because of differences in study design.…”

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confidence: 99%

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

et al. 2009

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Background-Atrial arrhythmias (AA) are an important cause of morbidity after cardiac surgery. Efforts at prevention of postoperative AA have been suboptimal. Perioperative beta-blocker administration is the standard of care at many centers. Although prophylactic administration of magnesium sulfate (MgSO 4 ) has been recommended, review of all previously published trials of MgSO 4 reveals conflicting results. This study was designed to address methodological shortcomings from previous studies and is the largest randomized, placebo-controlled trial of intravenous (IV) MgSO 4 for the prevention of AA after coronary artery bypass grafting or cardiac valvular surgery. Methods and Results-A total of 927 nonemergent cardiac surgery patients were stratified into 2 groups: isolated coronary artery bypass grafting (nϭ694), or valve surgery with or without coronary artery bypass grafting (nϭ233), and randomized to receive either 5g IV MgSO 4 or placebo on removal of the cross-clamp, followed by daily 4-hour infusions, from postoperative day 1 until postoperative day 4. All patients were treated according to an established oral ␤-blocker protocol. Postoperative serum Mg levels were checked and standard of care was to administer IV MgSO 4 for low serum levels. The primary end point was AA lasting Ն30 minutes or requiring treatment for hemodynamic compromise. There were no differences in the incidence of AA between patients who received IV MgSO 4 or placebo (26.4% versus 24.3%, respectively). The results were similar when broken down according to stratified groups. Conclusions-In patients treated with a protocol for postoperative oral ␤-blocker after nonemergent cardiac surgery, the addition of prophylactic IV MgSO 4 did not reduce the incidence of AA. (Circulation. 2009;120[suppl 1]:S163-S169.)

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“…Fanning et al [17] reported that the infusion of magnesium sulphate at the dose of 84 mmol/96 h reduced AF from 28% to 14.3% [17]; however, the decline was not statistically significant. Likewise, Jensen et al [18] demonstrated a non-statistical reduction in AF in patients treated with an infusion of 110 mmol Mg per 80 h [18].…”

Section: Discussionmentioning

confidence: 97%

Prophylactic Magnesium and Rhythm Disorders after Open Cardiac Surgery

Abbas

Khan

Abbas

et al. 2015

JCCR

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Objective: To evaluate the effect of intravenous magnesium, on prevention of postoperative cardiac arrhythmias after open cardiac surgery.Methodology: Prospective interventional study was conducted at Department Of Cardiac Surgery Punjab Institute Of Cardiology, Lahore from 1 st August 2011 to 31 st March 2012. Study groups included 260 consecutive patients undergoing CABG having normal sinus rhythm. They were classified as group I receiving magnesium supplementation perioperatively & group II not receiving magnesium supplementation. Intravenous Magnesium was administered before weaning from CPB and on 1 st postoperative day. Twelve-lead electrocardiograms were obtained immediately after operation and daily until detection of new onset arrhythmias. The distribution of both groups in CABG patients was compared for rhythm disorders. Results:The mean age of patients was 51.73±10.16 years. A total of 41 patients developed arrhythmias postoperatively. There was no mortality during the study in that specific group. Other analysis indicates there is an effect of intravenous Mg on the prevention of post cardiac arrhythmia after open heart surgery. Conclusion:Prophylactic administration of intravenous magnesium is associated with low incidence of postoperative cardiac arrhythmias.

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Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting

Cited by 170 publications

References 21 publications

Serum Magnesium Levels in Off - Pump Coronary Artery Bypass Grafting

Serum Magnesium Levels in Off - Pump Coronary Artery Bypass Grafting

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

Prophylactic Magnesium and Rhythm Disorders after Open Cardiac Surgery

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