Introduction: Perpetual controversy
Evidence for magnesium in atrial fibrillation
(2) Adjunctive agent for cardioversion
(3) Maintenance of sinus rhythm
(4) Improving rate control
(5) Overall efficacy in AF
Magnesium pharmacology: The rationale for a continuous infusion
Evidence: Magnesium infusions for critically ill patients with AF
Cardiac magnesium protocol: Putting evidence into practice
Where does magnesium fit in the greater context of AF treatment?
- Other therapies are contraindicated (e.g. patients in whom hypotension limits the ability to use beta-blockers or calcium-channel blockers). Aside from baseline hypermagnesemia or neuromuscular disease (e.g. myasthenia gravis), there are few contraindications to magnesium.
- Adjunctive agent for chemical cardioversion
- Patients with hypomagnesemia
- Critically ill patients (who may have a higher rate of subclinical magnesium deficiency than other populations)
- AF refractory to conventional therapies
More on this next week.
Parting shot: Magnesium infusion for Torsade de Pointes (TdP)
- Available evidence suggests that magnesium administration for atrial fibrillation may promote both rhythm and rate control.
- Magnesium may be the safest drug available for AF, when dosed and monitored appropriately.
- Magnesium is located predominantly within cells, so serum magnesium may be a poor measure of intracellular magnesium depletion. Rapid repletion of total body intracellular magnesium stores requires a magnesium infusion.
- Having a cardiac magnesium infusion protocol is very useful for torsade de pointes, where it may reduce the risk of recurrent cardiac arrest.
- EMCrit: The crashing AF patient
- Best Bets review: IV magnesium for AF
- Please note: The posts on this blog are oriented towards critically ill patients who develop AF as a complication of their critical illness. If you’re looking for information about outpatients who presents to the ED with AF as their primary problem, look at other FOAM resources e.g. ERCastand EMCases.