INTRODUCTION: Standard treatment for atrial tachyarrthmias, such as atrial fibrillation or atrial flutter, involves rate and rhythm control. Previous studies have looked at the electrophysiologic effects of magnesium on impulse formation and propagation, and theorized it could be beneficial in treatment for atrial tachycardias. There recently have been studies about magnesium sulfate and its utility in establishing rate and rhythm control in patients with atrial fibrillation or flutter.
METHODS: This systematic review used several databases to find five relevant articles regarding the use of intravenous magnesium sulfate in non-postoperative patients with atrial fibrillation or atrial flutter. The articles’ outcomes were ventricular rate control and return to normal sinus rhythm. Only randomized control trials that were double or single-blinded were used to ensure validity.
RESULTS: Both studies that used magnesium sulfate bolus and infusion in conjunction with an antiarrhythmic medication such as a beta blocker, calcium channel blocker, or digoxin, had better ventricular rate control. Only one of the two studies using magnesium sulfate with an antiarrhythmic medications had a better conversion to normal sinus rhythm. Of the three studies that did not use antiarrhythmic medication with magnesium sulfate, the study that used only use a bolus of magnesium sulfate did not have a beneficial effect in rate or rhythm control. The other two studies that did use a bolus and infusion of magnesium sulfate, but no other antiarrhythmics, had better efficacy in returning the patient to a normal sinus rhythm.
CONCLUSION: Magnesium sulfate, in conjunction with typical antiarrhythmics, given as a bolus and infusion is found to have greater efficacy in ventricular rate control and return to normal sinus rhythm. Further randomized control trials regarding specific dose of magnesium sulfate and antiarrhythmic medication needs to be pursued.
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