Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

Abstract

Background : Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results: We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I 2 =42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I 2 =17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I 2 =49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I 2 =51.8%, respectively). Conclusions: Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.

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“…On the contrary, in a study by Solomon et al in patients undergoing CABG, magnesium in combination with propranolol was not shown to further reduce the incidence of POAF compared to propranolol alone but significantly increased the incidence of hypotensive episodes [73]. Two meta-analyses confirmed the efficacy of magnesium in reducing POAF incidence after cardiac surgery [74,75]. Regarding the prevention of POAF with magnesium after non-cardiac thoracic surgery, as far as we know, the only available study, which showed the efficacy of this electrolyte, was carried out by Terzi et al in 1996 [76].…”

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“…These channels are typically activated by low concentrations of free magnesium [ 22 ]. In the Framingham Heart Study, it was shown low magnesium level after cardiac surgery was an indication for the onset of POAF [ 23 , 24 ]. A meta-analysis showed that treating patients prophylactically with magnesium in the post-operative period only led to a statistically significant decrease in POAF [ 25 ], suggesting the use of intravenous magnesium as an alternative to prevent POAF.…”

“…The proposed mechanism for hypomagnesium contributing to POAF is due to dilution from transfusion during surgery [ 47 ]. There has been debate in the literature about magnesium supplementation for treatment of POAF, and a meta-analysis showed that post-operative magnesium supplementation was the only time frame that significantly reduced the risk of POAF [ 24 ].…”

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“…The greatest attention has been pointed to the prevention of arrhythmias in high-risk patients undergoing cardiac surgery. A recent meta-analysis is supporting the data published in previous years on the role of prophylactic magnesium supplementation in the prevention of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery [ 33 ], especially when magnesium is given in the postoperative period [ 34 ]. Perioperative hypomagnesemia should have a crucial influence on cardiac adverse events after surgery [ 35 ] particularly on POAF, described as the most common cardiac complication occurred in cardiothoracic surgery [ 36 ].…”