Skip Navigation

European Heart Journal 2000 21(14):1177-1185; doi:10.1053/euhj.1999.1989
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (9)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Frick, M.
Right arrow Articles by Rosenqvist, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Frick, M.
Right arrow Articles by Rosenqvist, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

The effect of oral magnesium, alone or as an adjuvant to sotalol, after cardioversion in patients with persistent atrial fibrillation

M. Fricka,f1, B. Darpöb, J. Östergrenc and M. Rosenqvistb

a Department of Cardiology, South Hospital, Sweden
c Department of Medicine, Karolinska Hospital, Stockholm, Sweden
b Department of Cardiology, Karolinska Hospital, Stockholm, Sweden

revised October 18, 1999; accepted October 20, 1999

Abstract

Aims To determine whether magnesium given orally decreases the recurrence rate of atrial fibrillation after elective direct current cardioversion of persistent atrial fibrillation.

Methods and Results Consecutive outpatients were randomized to treatment with oral magnesium (10·3mmol) or placebo twice daily in a double-blind fashion. Two groups were studied; magnesium study: 170 patients with atrial fibrillation persistent for >1 month, scheduled for their first direct current cardioversion. No concomitant antiarrhythmic drugs of class I or III were allowed. Sotalol and magnesium study: 131 patients with recurrence of persistent atrial fibrillation after previous direct current cardioversion, or a history of paroxysmal atrial fibrillation, treated with sotalol. Patients were followed until recurrence of atrial fibrillation or for at least 6 months. Magnesium study: at cardioversion 67 of 85 (79%) in the placebo group and 64 of 85 (75%) in the magnesium group had converted to sinus rhythm. At the end of the study, with a follow-up of 6 to 42 months, 15% of patients in the placebo group and 19% of patients in the magnesium group remained in sinus rhythm (Log rank test: P=0·37). Sotalol and magnesium study: pharmacological conversion to sinus rhythm, after oral treatment, was achieved in 34 of 131 (26%) patients. Sinus rhythm, with or without cardioversion, was restored in 89% and 85% of the patients in the placebo and magnesium groups, respectively. At the end of the study, with a follow-up of 6 to 42 months, 37% of patients in the placebo group and 30% of patients in the magnesium group remained in sinus rhythm (Log rank test:P =0·64).

Conclusion In patients with persistent atrial fibrillation, oral treatment with magnesium alone or as an adjuvant to sotalol, does not influence the recurrence rate of atrial fibrillation after elective cardioversion.

Key Words: Atrial fibrillation, cardioversion, magnesium, sotalol, arrhythmias

f1 Correspondence: Mats Frick, MD, Department of Cardiology, South Hospital, S-118 83 Stockholm, Sweden.

References

  1. Benjamin EJ, Wolf PA, D'Agostino RB. Impact of atrial fibrillation on the risk of death: The Framingham study. Circulation. 1998;98:946–952[Abstract/Free Full Text]
  2. Lown B. Electrical reversion of cardiac arrhythmias. Br Heart J. 1962;29:469–489
  3. Coplen SE, Antman EM, Belin JA, Hewitt P, Chalmers TC. Efficacy and safety of quinidine therapy for the maintenance of sinus rhythm after cardioversion. Circulation. 1990;82:1106–1116[Abstract/Free Full Text]
  4. Sopher SM, Camm AJ. Atrial fibrillation: maintenance of sinus rhythm versus rate control. Am J Cardiol. 1996;77:24–37
  5. Juul-Möller S, Edvardsson N, Rehnqvist-Ahlberg N. Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Circulation. 1990;82:1932–1939[Abstract/Free Full Text]
  6. Reimold SC, Cantillon CO, Friedman PL, Antman EM. Propafenone versus sotalol for suppression of recurrent symtomatic atrial fibrillation. Am J Cardiol. 1993;71:558–563[CrossRef][ISI][Medline]
  7. Kulick DL, Hong R, Ryzen E. Electrophysiologic effects of intravenous magnesium in patients with normal conduction systems and no clinical evidence of cardiac disease. Am Heart J. 1988;115:367–373[CrossRef][ISI][Medline]
  8. DiCarlo LA, Morady F, Buitleir M, Krol RB, Schurig L, Annesley TM. Effects of magnesium sulphate on cardiac conduction and refractoriness in humans. J Am Coll Cardiol. 1986;7:1356–1362[Abstract]
  9. Perticone F, Ceravalo R, Costa R, Mattioli PL. Electrophysiologic effects of magnesium sulphate infusion in patients with cardiac conduction defects. J Am Coll Nutrition. 1992;11:405–409[Abstract]
  10. Gullestad L, Birkeland K, Molstad P, Hoyer MM, Vanberg P, Kjekshus J. The effect of magnesium versus verapamil on supraventricular arrhythmias. Clin Cardiol. 1993;16:429–434[ISI][Medline]
  11. Moran JL, Gallagher J, Peake SL, Cunningham DN, Salagaras M, Leppard P. Parenteral magnesium sulphate versus amiodaron in therapy of atrial tachyarrhythmias: a prospective, randomized study. Critical Care Med. 1995;23:1816–1824[CrossRef][ISI][Medline]
  12. Singh RB, Manmohan MD, Dube KP, Singh VP. Serum magnesium in atrial fibrillation. Acta Cardiol. 1976;3:221–226
  13. DeCarli C, Sprouse G, Larosa JC. Serum magnesium levels in symtomatic atrial fibrillation and their relation to rhythm control by intravenous digoxin. Am J Cardiol. 1986;57:956–959[CrossRef][ISI][Medline]
  14. Reinhart R, Marx J, Broste S, Haas R. Myocardial magnesium: Relation to labatory and clinical variables in patients undergoing cardiac surgery. J Am Coll Cardiol. 1991;17:651–656[Abstract]
  15. Schweiger I, Kopel ME, Finlayson DC. Magnesium and postoperative dysrhythmias in patients after cardiac surgery. J Thoracic Anesthesiology. 1989;3:18
  16. Fanning W, Thomas C, Roach A, Tomichek R, Alford W, Stoney W. Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann Thorac Surg. 1991;52:529–533[Abstract]
  17. Coulquhoun I, Berg G, El-Fiky M, Hurle A, Fell G, Wheathly D. Arrhythmia orophylactics after coronary artery surgery. A randomised controlled trial of intravenous magnesium chloride. Eur J Cardiothorac Surg. 1993;10:520–523
  18. Parikka H, Toivonen L, Pellinen T, Verkala K, Järvinen A, Nieminen S. The influence of intravenous magnesium sulphate on the occurrence of atrial fibrillation after coronary artery bypass operation. Eur Heart J. 1993;14:251–258[Abstract/Free Full Text]
  19. Lewis RV, Tregaskis B, McLay J, McDevitt DG. Oral magnesium reduces ventricular ectopy in digitalised patients with chronic atrial fibrillation. Eur J Clin Pharmacol. 1990;38:107–110[CrossRef][ISI][Medline]
  20. Bashir Y, Staunton H, Mckenna W, Ward D, Camm A. Controlled trial of magnesium chloride supplementation in chronic heart failure. Eur Heart J. 1991;12:76
  21. Krasner BS, Girdwood R, Smith H. The effect of slow releasing oral magnesium chloride on the QTcinterval of the electrocardiogram during open heart surgery. Canad Anaesth Soc J. 1981;4:329–333
  22. Van Gelder IC, Crinjs HJ, Van Gilst WH, Verwer R, Lie KI. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation. Am J Cardiol. 1991;68:41–46[ISI][Medline]
  23. Wesley RC, Haines DE, Lerman B, Dimarco JP, Cramton RS. Effect of magnesium sulphate on supraventricular tachycardia. Am J Cardiol. 1989;63:1129–1131[CrossRef][ISI][Medline]
  24. Hohnloser SH, Van de Loo A, Baedecker F. Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: Prospective comparison of sotalol versus quinidine. J Am Coll Cardiol. 1995;26:852–858[Abstract]
  25. Van Gelder IC, Crinjs HJ, Tieleman RG. Success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med. 1996;156:2585–2592[Abstract]
  26. Chun SH, Sager PT, Stevenson WG, Nadamanee K, Middlekauf HR, Singh BN. Long term efficacy of amiodarone for the maintenance of normal sinus rhythm in patients with refractory atrial fibrillation or flutter. Am J Cardiol. 1995;76:47–50[CrossRef][ISI][Medline]
  27. Wijfells MCEF, Kirchof CJHJ, Dorland R, Allesie MA. AF begets AF: a study in awake chronically instrumented goats. Circulation. 1995;92:1954–1968[Abstract/Free Full Text]
  28. De Simone A, Stabile G, Vitale DF. Pretreatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical cardioversion. J Am Coll Cardiol. 1999;34:810–814[Abstract/Free Full Text]
  29. MacNeil DJ, Davies KO, Deitcman D. Clinical safety profile of sotalol in the treatment of arrhythmias. Am J Cardiol. 1993;72:44A–50A[Medline]
  30. Tzivoni A, Keren. Suppression of ventricular arrhythmias by magnesium. Am J Cardiol. 1990;65:1397–1399[CrossRef][ISI][Medline]
  31. Brodsky MA, Orlov MV, Caparelli EV. Magnesium therapy in new-onset atrial fibrillation. Am J Cardiol. 1994;73:1227–1229[CrossRef][ISI][Medline]
  32. Frick M, Östergren J, Rosenqvist M. The effects of iv magnesium on heart rate and heart rate variability in patients with chronic atrial fibrillation. Am J Cardiol. 1999;84:104–108[CrossRef][ISI][Medline]
  33. Ralston, MA, Murnane, MR, Kelley, RE, Altschuld, RA, Unverferth, DV, Leier, CV, Magnesium content of serum, circulating mononuclear cells, skeletal muscle, and myocardium in congestive heart failure, Circulation, 80, 573, 80
  34. Giles TD, Chobain AV. Magnesium deficiency: a new cardiovascular risk factor. ‘Magnesium deficiency: A new cardiovascular risk factor in sudden death?’. Fort Lee: Health Care Communications; 1990. p. 1–24

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
H.H. Veloso
Effects of oral sotalol administration before electrical cardioversion of persistent atrial fibrillation
Eur. Heart J., August 2, 2001; 22(16): 1512 - 1514.
[PDF]

Home page
 Eur Heart JHome page
P. Brugada
Magnesium: an antiarrhythmic drug, but only against very specific arrhythmias
Eur. Heart J., July 2, 2000; 21(14): 1116 - 1116.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (9)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Frick, M.
Right arrow Articles by Rosenqvist, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Frick, M.
Right arrow Articles by Rosenqvist, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?