Document Type : Original Article
Authors
1 Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background: Cardiac arrhythmias, especially atrial fibrillation, are among the most common early complications of open-heart surgery. Hypomagnesemia is one of the clinical mechanisms associated with the pathogenesis of postoperative atrial fibrillation. This study aimed to evaluate the effect of magnesium sulfate on the prevention of atrial fibrillation in patients with abnormal P-wave duration who underwent coronary artery bypass graft (CABG)surgery.
Methods: In this clinical trial, 150 patients participated who had undergone CABG surgery at Imam Khomeini hospital in Ahvaz in 2014. According to the inclusion criteria, the intervention and control groups were randomly matched. The intervention group, consisting of 57 patients, received 2.4 g of magnesium sulfate daily for three days and 75 patients of the control group received a placebo. Prevention of postoperative atrial fibrillation by magnesium sulfate was evaluated in patients and data were analyzed using SPSS software.
Results: The two groups did not have a significant difference in terms of gender, diabetes, hyperlipidemia, and hypertension. Also, mean P-wave duration, length of intensive care unit stay, the total length of hospitalization, left ventricular ejection fraction (LVEF), distribution of creatinine, atrial fibrillation, and aortic clamp time in intervention and control groups were not statistically significant. Only, the total pump duration difference was reported to be statistically significant between groups.
Conclusion: The results of our study showed that the administration of magnesium sulfate alone cannot be helpful in the prevention of atrial fibrillation among patients with long P-wave duration.
Trial Registration: https://www.irct.ir/, Identifier: IRCT2015092814190N9
Keywords
Postoperative atrial fibrillation: mechanisms, manifestations
and management. Nat Rev Cardiol. 2019;16(7):417-36. doi:
10.1038/s41569-019-0166-5.
2. Freeman JV, Simon DN, Go AS, Spertus J, Fonarow GC,
Gersh BJ, et al. Association between atrial fibrillation
symptoms, quality of life, and patient outcomes: results from
the Outcomes Registry for Better Informed Treatment of Atrial
Fibrillation (ORBIT-AF). Circ Cardiovasc Qual Outcomes.
2015;8(4):393-402. doi: 10.1161/circoutcomes.114.001303.
3. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology
of atrial fibrillation: an increasing epidemic and public
health challenge. Int J Stroke. 2021;16(2):217-21. doi:
10.1177/1747493019897870.
4. Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov
AM. New-onset atrial fibrillation after cardiac surgery:
pathophysiology, prophylaxis, and treatment. J Cardiothorac
Vasc Anesth. 2016;30(1):200-16. doi: 10.1053/j.
jvca.2015.08.003.
5. Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA,
Nair GM, et al. Interventions for preventing post-operative
atrial fibrillation in patients undergoing heart surgery.
Cochrane Database Syst Rev. 2013;2013(1):CD003611. doi:
10.1002/14651858.CD003611.pub3.
6. Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-
Coello P. Postoperative atrial fibrillation in non-cardiac and
cardiac surgery: an overview. J Thromb Haemost. 2015;13
Suppl 1:S304-12. doi: 10.1111/jth.12974.
7. Laiq N, Khan RA, Mailk A, Ahmad H. Intravenous magnesium
prevents atrial fibrillation after valvular heart surgery. J Med
Sci. 2013;21(2):77-80.
8. Gudbjartsson T, Helgadottir S, Sigurdsson MI, Taha A,
Jeppsson A, Christensen TD, et al. New-onset postoperative
atrial fibrillation after heart surgery. Acta Anaesthesiol Scand.
2020;64(2):145-55. doi: 10.1111/aas.13507.
9. Kolte D, Vijayaraghavan K, Khera S, Sica DA, Frishman WH.
Role of magnesium in cardiovascular diseases. Cardiol Rev.
2014;22(4):182-92. doi: 10.1097/crd.0000000000000003.
10. Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Motedayen
M. Evaluating the effect of magnesium supplementation
and cardiac arrhythmias after acute coronary syndrome:
a systematic review and meta-analysis. BMC Cardiovasc
Disord. 2018;18(1):129. doi: 10.1186/s12872-018-0857-6.
11. Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Heyat
Khabaz A, Fakhari S. Effect of prophylaxis of magnesium
sulfate for reduction of postcardiac surgery arrhythmia:
randomized clinical trial. Ann Card Anaesth. 2016;19(4):662-
7. doi: 10.4103/0971-9784.191577.
12. Gholipour Baradari A, Emami Zeydi A, Ghafari R, Aarabi M,
Jafari M. A double-blind randomized clinical trial comparing
different doses of magnesium in cardioplegic solution for
prevention of atrial fibrillation after coronary artery bypass
graft surgery. Cardiovasc Ther. 2016;34(4):276-82. doi:
10.1111/1755-5922.12198.
13. Taksaudom N, Cheewinmethasiri J, Chittawatanarat K,
Nawarawong W, Ko-iam W, Sudthiviseschai P. Magnesium
sulfate reduces incidence of atrial fibrillation after coronary
arterial bypass surgery: what is the proper dose? A randomized
trial. J Med Assoc Thai. 2016;99(7):794-801.
14. Zaouche K, Mhadhbi H, Boubaker R, Baccouche R, Khattech
I, Majed K. Magnesium Sulfate: an adjunctive therapy in the
first hour of management of rapid atrial fibrillation in the
emergency department. Tunis Med. 2021;99(2):225-31.
15. Fairley JL, Zhang L, Glassford NJ, Bellomo R. Magnesium
status and magnesium therapy in cardiac surgery: a systematic
review and meta-analysis focusing on arrhythmia prevention.
J Crit Care. 2017;42:69-77. doi: 10.1016/j.jcrc.2017.05.038.
16. Cook RC, Yamashita MH, Kearns M, Ramanathan K, Gin K,
Humphries KH. Prophylactic magnesium does not prevent
atrial fibrillation after cardiac surgery: a meta-analysis.
Ann Thorac Surg. 2013;95(2):533-41. doi: 10.1016/j.
athoracsur.2012.09.008.
17. Lomivorotov VV, Efremov SM, Karaskov AM. Pharmacokinetics
of magnesium in cardiac surgery: implications for prophylaxis
against atrial fibrillation. J Cardiothorac Vasc Anesth.
2018;32(3):1295-6. doi: 10.1053/j.jvca.2017.09.023.
18. Schaffer A, Verdoia M, Cassetti E, Marino P, Suryapranata H,
De Luca G. Relationship between homocysteine and coronary
artery disease. Results from a large prospective cohort
study. Thromb Res. 2014;134(2):288-93. doi: 10.1016/j.
thromres.2014.05.025.
19. Shimony A, Afilalo J, Flynn AW, Langleben D, Agnihotri AK,
Morin JF, et al. Usefulness of right ventricular dysfunction
to predict new-onset atrial fibrillation following coronary
artery bypass grafting. Am J Cardiol. 2014;113(6):913-8. doi:
10.1016/j.amjcard.2013.11.048.
20. Caldonazo T, Kirov H, Rahouma M, Robinson NB, Demetres
M, Gaudino M, et al. Atrial fibrillation after cardiac surgery:
a systematic review and meta-analysis. J Thorac Cardiovasc
Surg. 2021. doi: 10.1016/j.jtcvs.2021.03.077.
21. Yan YQ, Zou LJ. Relation between zinc, copper, and
magnesium concentrations following cardiopulmonary
bypass and postoperative atrial fibrillation in patients
undergoing coronary artery bypass grafting. Biol Trace Elem
Res. 2012;148(2):148-53. doi: 10.1007/s12011-012-9356-2.
22. Magnani JW, Johnson VM, Sullivan LM, Gorodeski EZ,
Schnabel RB, Lubitz SA, et al. P wave duration and risk of
longitudinal atrial fibrillation in persons ≥ 60 years old (from
the Framingham Heart Study). Am J Cardiol. 2011;107(6):917-
21.e1. doi: 10.1016/j.amjcard.2010.10.075.
23. Kohno H, Koyanagi T, Kasegawa H, Miyazaki M. Threeday
magnesium administration prevents atrial fibrillation
after coronary artery bypass grafting. Ann Thorac Surg.
2005;79(1):117-26. doi: 10.1016/j.athoracsur.2004.06.062.
Payami et al
546 Journal of Kerman University of Medical Sciences. Volume 29, Number 6, 2022
24. Osawa EA, Cutuli SL, Cioccari L, Bitker L, Peck L, Young H, et
al. Continuous magnesium infusion to prevent atrial fibrillation
after cardiac surgery: a sequential matched case-controlled
pilot study. J Cardiothorac Vasc Anesth. 2020;34(11):2940-7.
doi: 10.1053/j.jvca.2020.04.006.
25. Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir
T, et al. 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.
J Atr Fibrillation. 2019;12(1):2154. doi: 10.4022/jafib.2154.
26. Wu F, Wu Y, Tao W, Zhao H, Shen D. Preoperative P-wave
duration as a predictor of atrial fibrillation after coronary
artery bypass grafting: a prospective cohort study with metaanalysis.
Int J Nurs Sci. 2018;5(2):151-6. doi: 10.1016/j.
ijnss.2018.04.003.
27. Lancaster TS, Schill MR, Greenberg JW, Moon MR, Schuessler
RB, Damiano RJ Jr, et al. Potassium and magnesium
supplementation do not protect against atrial fibrillation after
cardiac operation: a time-matched analysis. Ann Thorac Surg.
2016;102(4):1181-8. doi: 10.1016/j.athoracsur.2016.06.066.
)