Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.

Osawa, Eduardo A; Cutuli, Salvatore L; Cioccari, Luca; Bitker, Laurent; Peck, Leah; Young, Helen; Hessels, Lara; Yanase, Fumitaka; Fukushima, Julia T; Hajjar, Ludhmila A; Seevanayagam, Siven; Matalanis, George; Eastwood, Glenn M; Bellomo, Rinaldo (2020). Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study. Journal of cardiothoracic and vascular anesthesia, 34(11), pp. 2940-2947. Elsevier 10.1053/j.jvca.2020.04.006

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OBJECTIVE

The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery.

DESIGN

Sequential, matched, case-controlled pilot study.

SETTING

Tertiary university hospital.

PARTICIPANTS

Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol.

INTERVENTIONS

The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge.

MEASUREMENTS AND MAIN RESULTS

The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L ± 0.34 on day 1, 1.32 ± 0.36 on day 2 versus 1.01 ± 1.14 and 0.97 ± 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004).

CONCLUSION

The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.

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