Association of prophylactic intravenous magnesium sulfate for prevention of post cardiac surgery arrhythmias

M. Faysal Ahmed; Syeda N. Hossain; Manjurul Hasan; Mohammad M. Haque; Sirajum Munira; Samsun Nahar

doi:10.18203/2349-2902.isj20252671

Authors

M. Faysal Ahmed Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
Syeda N. Hossain Department of Gynaecology and Obstetrics, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
Manjurul Hasan Department of Vascular Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Mohammad M. Haque Department of Surgery, Director General Health Services, Mohakhali, Dhaka, Bangladesh
Sirajum Munira National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
Samsun Nahar Department of Biochemistry, Bashundhara Ad-din Medical College and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20252671

Keywords:

Intravenous magnesium sulphate, Cardiac surgery, Arrhythmia

Abstract

Background: Arrhythmia is a common complication after heart surgery and is a major source of morbidity and mortality. In this study we aimed to investigate the effectiveness of prophylactic magnesium sulfate in the reduction of post-operative arrhythmia after cardiac surgery.

Methods: This comparative cross sectional study was carried out in the Department of Cardiac Surgery, National Institute of Cardiovascular Disease (NICVD), Sher E Bangla Nagar, Dhaka from 01 January 2022 to 31 December 2023. Total 100 patients were selected on the basis of inclusion and exclusion criteria. Among them 50 patients (group A) received prophylactic IV magnesium sulfate and other 50 patients (group B) did not receive prophylactic IV magnesium sulfate. A p value <0.05 was considered statistically significant.

Results: During the observation period overall, 31 out of 100 patients (31%) developed postoperative arrhythmia with varying severity. Among them, 10 patients were from group-A (prophylactic IV magnesium sulfate group) and 21 patients belonged to group-B (control group) (20% versus 42%; p=0.017). Duration of mechanical ventilation (6.89±3.95 versus 10.22±4.56 hours; p<0.001), ICU stay (4.48±2.29 versus 9.83±4.12 days; p<0.001) and length of postoperative hospital stay (7.86±3.04 versus 12.83±4.98 days; p<0.001) were also found to be significantly prolonged in group B patients. No significant difference was observed between the two groups in regards to demographics, associated risk factors, baseline cardiac function, type of disease, operative time and use of CPB (p>0.05).

Conclusions: The current research indicated that administering prophylactic intravenous magnesium sulfate could effectively decrease the occurrence of early postoperative arrhythmia in patients undergoing cardiac surgery.

Metrics

Metrics Loading ...

References

Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 2006;27(23):2846-57. DOI: https://doi.org/10.1093/eurheartj/ehl272

Fu DG. Cardiac Arrhythmias: Diagnosis, Symptoms, and Treatments. Cell Biochem Biophys. 2015;73(2):291-6. DOI: https://doi.org/10.1007/s12013-015-0626-4

Khairy P, Balaji S. Cardiac arrhythmias in congenital heart diseases. Indian Pacing Electrophysiol J. 2009;9(6):299-317.

Shakerinia T, Ali IM, Sullivan JA. Magnesium in cardioplegia: is it necessary? Can J Surg. 1996;39(5):397-400.

Sultan A, Steven D, Rostock T, Hoffmann B, Müllerleile K, Servatius H, et al. Intravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation. J Cardiovasc Electrophysiol. 2012;23(1):54-9. DOI: https://doi.org/10.1111/j.1540-8167.2011.02146.x

Shakerinia T, Ali IM, Sullivan JA. Magnesium in cardioplegia: Is it necessary? Can J Surg. 1996;39:397-400.

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. 2023;95:533-41. DOI: https://doi.org/10.1016/j.athoracsur.2012.09.008

Gu WJ, Wu ZJ, Wang PF, Aung LH, Yin RX. Intravenous magnesium prevents atrial fibrillation after coronary artery bypass grafting: A meta-analysis of 7 double-blind, placebo-controlled, randomized clinical trials. Trials. 2012;13:41. DOI: https://doi.org/10.1186/1745-6215-13-41

Rajagopalan B, Narasimha D, Bhatia A, Kim CH, Switzer DF, Curtis AB. Efficacy of intravenous magnesium for cardioversion of atrial fibrillation. Circulation. 2018;130(Suppl 2):A13495.

Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: A meta-analysis. Circulation. 2022;106:75-80. DOI: https://doi.org/10.1161/01.CIR.0000021113.44111.3E

Tapio H, Jari H, Kimmo M, Juha H. Prevention of atrial fibrillation after cardiac surgery. Scand Cardiovasc J. 2017;41:72-8. DOI: https://doi.org/10.1080/14017430601054076

Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2014;43:742-8. DOI: https://doi.org/10.1016/j.jacc.2003.11.023

Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997;336:1429. DOI: https://doi.org/10.1056/NEJM199705153362006

Jedwab RM, Hutchinson AM, Redley B. Magnesium sulphate replacement therapy in cardiac surgery patients: A systematic review. Aust Crit Care. 2019;32(5):421-33. DOI: https://doi.org/10.1016/j.aucc.2018.09.004

Zangrillo A, Landoni G, Sparicio D, Pappalardo F, Bove T, Cerchierini E, et al. Perioperative magnesium supplementation to prevent atrial fibrillation after off-pump coronary artery surgery: a randomized controlled study. J Cardiothorac Vasc Anesth. 2005;19(6):723-8. DOI: https://doi.org/10.1053/j.jvca.2005.02.015

Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Khabaz AH, 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: https://doi.org/10.4103/0971-9784.191577

Najafi M, Haghighat B, Tafti HA. Relationship between serum magnesium level and arrythmias following post-coronary artery bypass grafting. Middle East J Anaesthesiol. 2007;19(3):661-72.

Kaplan M, Kut MS, Icer UA, Demirtas MM. Intravenous magnesium sulfate prophylaxis for atrial fibrillation after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2003;125(2):344-52. DOI: https://doi.org/10.1067/mtc.2003.108

Dorman BH, Sade RM, Burnette JS, Wiles HB, Pinosky ML, Reeves ST, et al. Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. Am Heart J. 2000;139(3):522-8. DOI: https://doi.org/10.1016/S0002-8703(00)90097-8