ROLE OF MAGNESIUM IN PREVENTING POST-OPERATIVE ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS SURGERY

Muhammad Bakhsh, Safdar Abbas, Raja Mushtaq Hussain, Safdar Ali Khan, SM Shahab Naqvi

Abstract


Objective: To assess the role of 3 days of magnesium infusion after coronary artery bypass graft
(CABG) surgery in preventing postoperative atrial fibrillation (AF). Place and Duration of Study:
Armed Forces Institute of Cardiology (AFIC) & National Institute of Heart Diseases (NIHD),
Rawalpindi, from July 2006 to June 2007. Design: Prospective, randomized, non-blinded. Methods:
All patients undergoing isolated, initial CABG surgery, and having sinus rhythm before surgery were
alternatively randomized into the study or the control group. The exclusion criteria included: history of
AF, implanted pacemaker, myocardial infarction postoperatively, use of left ventricular assist devices
and renal failure. The patients in the study group received 10 mmol of magnesium sulphate (2.47 gm)
dissolved in 100 ml of saline solution infused intravenously over 4 hours, for 3 days. The end point was
development of AF for at least 15 minutes or more, or if an episode of AF had to be treated because of
symptoms. Results: A total of 220 patients were included in the study, 110 in each group. The
incidence of AF was 9% in patients who received the three days of magnesium infusion. The patients
without magnesium had an AF incidence of 23% (p<0.001). The hospital stay was also less in the
treated group (p=0.055). Conclusion: A 3-days postoperative infusion of magnesium is safe and
effective in reduction of possibly life-threatening AF, in patients undergoing primary coronary artery
bypass surgery.
Keywords: Coronary artery bypass surgery; Postoperative Atrial fibrillation; Magnesium.

Full Text:

PDF

References


Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer

CD, et al. A multicenter risk index for atrial fibrillation after

cardiac surgery. JAMA 2004;291:1720–9.

Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS,

VanderVleit M, et al. Predictors of atrial fibrillation after

coronary artery surgery: current trends and impacts on

hospital resources. Circulation 1996;94:390–7.

Funk M, Richards SB, Desjardins J, Bebon C, Wilcox H.

Incidence, timing, symptoms and risk factors for atrial

fibrillation after cardiac surgery. Am J Crit Care

;12:424–33.

Hogue CW Jr, Murphy SF, Schechtman KB, Davila-Roman

VG. Risk factors for early or delayed stroke after cardiac

surgery. Circulation 1999;100:642–7.

Mathew JP, Parks R, Savino JS, Friedman AS, Koch C,

Mangano DT, et al. Atrial fibrillation following coronary

artery bypass graft surgery: predictors, outcomes, and

resource utilization. JAMA 1996;276:300–6.

Kohno H, Koyanagi T, Kasegawa H, Miyazaki M. Three-day

magnesium administration prevents atria fibrillation after

coronary artery bypass grafting. Ann Thorac Surg

;79:117–26.

Shiga T, Wajima Z, Inuoue T, Ogawa R. Magnesium

prophylaxis for arrhythmias after cardiac surgery: a metaanalysis of randomized controlled trials. Am J Med

;117:325–33.

Toyuz RM. Magnesium in clinical medicine. Frontiers in

Bioscience. 2004;9:1278–93.

Statistical Department Report. Armed Forces Institute of

Cardiology. Rawalpindi. 2006.

Ali A, Khan IS, Rajput MZ, Ahmed SA, Naqvi S, Zaheer

HA. Atrial fibrillation and other arrhythmias in patients early

after coronary artery bypass (CABG) surgery. Ann Pak Inst

Med Sci 2005;1:136–9.

Malik A, Bangash SK, Haq MI, Rehman M, Hussain M.

Atrial fibrillation after coronary artery bypass graft surgery. J

Postgrad Med Inst 2006;20:143–8.

Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF,

Gutteridge G, et al. Atrial fibrillation after coronary artery

bypass grafting is associated with sympathetic activation.

Ann Thorac Cardiovasc Surg 2003;125:344–52.

Henyan NN, Gillespie EL, White CM, Kluger J, Coleman CI.

Impact of intravenous magnesium on post-cardiothoracic

surgery atrial fibrillation and length of hospital stay: A metaanalysis. Ann Thorac Surg 2005;80:2402–6.

Mayson SE, Greenspon AJ, Adams S, Decaro MV, Sheth M,

Weitz HH, et al. The changing face of post-operative atrial

fibrillation prevention: a review of current medical therapy.

Cardiol Rev 2007;15:231–41.

Hazelrigg SR, Boley TM, Cetindag IB, Moulton KP,

Trammell GL, Polancic GE, et al. The efficacy of

supplemental magnesium in reducing atrial fibrillation after

coronary artery bypass grafting. Ann Thorac Surg

;77:824–30.

Bert AA, Reinert SE, Singh AK. A β-blocker, not

magnesium, is effective prophylaxis for atrial

tachyarrhythmias after coronary artery bypass grat surgery. J

Cardiothorac Vasc Anes 2001;15:204–9.

Tiryakioglu O, Demirtas S, Ari H, Tiryakioglu SK, Huysal

K, Selimoglu O, et al. Magnesium sulphate and amiodarone

prophylaxis for prevention of postoperative arrhythmia in

coronary by-pass operations. J Cardiothorac Surg 2009;4:8.

Kaplan M, Sinan M, Icer UA, Demirtas MM. Intravenous

magnesium sulfate prohylaxis for atrial fibrillation after

coronary artery bypass surgery. J Thorac Cardiovas Surg

;125:344–52.

Toraman F, Karabulut EH, Alhan HC, Dagdelen S, Tarcan S.

Magnesium infusion dramatically decreases the incidence of

atrial fibrillation after coronary artery bypass grafting. Ann

Thorac Surg 2001;72:1256–62.

Najafi M, Hamidian R, Haghighat B, Fallah N, Tafti HA,

Karimia A, et al. Magnesium infusion and postoperative

atrial fibrillation: a randomized clinical trial. Acta

Anesthesiol Taiwan 2007;45:89–94.

Ho KM, Lewis JP. Prevention of atrial fibrillation in cardiac

surgery: time to consider a multimodality pharmacological

approach. Cardivasc Ther 2010;28:59–65.

Cook RC, Humphries KH, Gin K, Jansuz MT, Slavik RS,

Berstein V, et al. Prophylactic intravenous magnesium

sulphate in addition to oral {beta}-blockade does not prevent

atrial arrhythmias after coronary artery or valvular heart

surgery: a randomized, controlled trial. Circulation

;120:S163–9.

Shrivastava R, Smith B, Caskey D, Reddy P. Atrial

fibrillation after cardiac surgery: does prophylactic therapy

decrease adverse outcomes associated with atrial fibrillation.

Intensive Care Med 2009;24:18–25.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]