What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: New-onset atrial fibrillation (n=4654). Intervention: Magnesium vs. Placebo. Primary outcome: Incidence of new-onset atrial fibrillation (OR 0.72, 95% CI 0.48 to 1.09).

October 26, 2023Open Access

Magnesium prophylaxis of new-onset atrial fibrillation: A systematic review and meta-analysis

Q: What does this research mean for the field?

Administration of magnesium does not significantly reduce the incidence of new-onset atrial fibrillation compared to placebo in non-cardiac surgery patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Administration of magnesium did not significantly reduce the incidence of new-onset atrial fibrillation compared to placebo in non-cardiac surgery patients (OR 0.72).

Study Design

Type

Meta-Analysis (n=4,654)

Structured PICO

Does magnesium prophylaxis reduce the incidence of new-onset atrial fibrillation in non-cardiac surgery patients?

Population

4,654 patients from 4 randomized controlled trials (pooled analysis) outside the setting of cardiac surgery, including populations with acute myocardial infarction, post-thoracic surgery, lobectomy, and acute stroke.

Intervention

Magnesium prophylaxis (various doses and routes, including intravenous bolus/infusion and oral administration) as a class.

Comparator

Placebo (matching volumes of saline or oral placebo) or no treatment (including historical controls in one study).

Outcome

Incidence of new onset atrial fibrillation (NOAF)

Magnesium prophylaxis does not significantly reduce the incidence of new-onset atrial fibrillation in non-cardiac surgery patients, though current evidence is limited by high heterogeneity and risk of bias.

Main Result

Effect estimate: OR 0.72 (95% CI 0.48 to 1.09)

Limitations

Small number of included studies
No studies in general critically ill patients
High risk of bias due to lack of blinding and selective reporting
Significant heterogeneity in patient populations, interventions, and detection of NOAF
Two largest studies were secondary analyses where atrial fibrillation was not the primary outcome

Abstract

PURPOSE: Atrial fibrillation (AF) is the most common cardiac arrhythmia in intensive care units (ICU) and is associated with increased morbidity and mortality. Magnesium prophylaxis has been shown to reduce incidence of AF in cardiac surgery patients, however, evidence outside this population is limited. The objective of this study is to summarize studies examining magnesium versus placebo in the prevention of NOAF outside the setting of cardiac surgery. SOURCE: We performed a comprehensive search of MEDLINE, EMBASE, and Cochrane Library (CENTRAL) from inception until January 3rd, 2023. We included all interventional research studies that compared magnesium to placebo and excluded case reports and post cardiac surgery patients. We conducted meta-analysis using the inverse variance method with random effects modelling. PRINCIPAL FINDINGS: Of the 1493 studies imported for screening, 87 full texts were assessed for eligibility and six citations, representing five randomized controlled trials (n = 4713), were included in the review, with four studies (n = 4654) included in the pooled analysis. Administration of magnesium did not significantly reduce the incidence of NOAF compared to placebo (OR 0.72, 95% CI 0.48 to 1.09). CONCLUSION: Use of magnesium did not reduce the incidence of NOAF, however these studies represent diverse groups and are hindered by significant bias. Further studies are necessary to determine if there is benefit to magnesium prophylaxis for NOAF in non-cardiac surgery patients.

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