What does this research mean for the field?

Raising serum magnesium levels above 3.8 mg/dl significantly improves the efficacy of ibutilide in converting persistent atrial fibrillation or flutter to sinus rhythm in patients with rheumatic heart disease. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 1, 2020Indian Heart JournalOpen Access

Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients

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Why the study?

Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic AF and flutter to sinus rhythm were lacking.

Does adjunctive intravenous magnesium supplementation improve the efficacy of ibutilide for the conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm?

Population

33 Rheumatic heart disease patients with persistent AF or AFl

Comparison

Intravenous magnesium prior to ibutilide administration

Design

Prospective study

Authors

AMAmit MalviyaNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences MKManish KapoorNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences RSRondeep kumar Nath SivamNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences

Discussion

Member takes

Implication

Magnesium level was associated with ibutilide success in rheumatic AF; hypothesis-generating and requires randomized trials before practice change.

Structured PICO

Does adjunctive intravenous magnesium supplementation improve the efficacy of ibutilide for the conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm?

Population

33 patients with rheumatic heart disease (13 males, 20 females), mean age 49.27 ± 11.4 years, with persistent atrial fibrillation or flutter (>7 days). Key inclusion: QTc ≤440 ms, stable hemodynamics, normal serum magnesium and potassium levels. Key exclusion: Paroxysmal atrial fibrillation, history of myocardial infarction within the previous 30 days, polymorphic ventricular tachycardia, hyperpyrexia, thyrotoxicosis, symptoms of congestive heart failure, bradycardia, known ibutilide hypersensitivity.

Intervention

Intravenous magnesium (2 g i.v. thrice daily for 3 days to attain serum levels of 4-4.5 mg/dl, plus a 4 mg bolus 2 h before ibutilide) followed by intravenous ibutilide (1 mg over 10 min, with a second 1-mg dose if arrhythmia persisted).

Outcome

Rate of conversion of atrial fibrillation and atrial flutter (AFl) to normal sinus rhythm.surrogate

Raising serum magnesium levels above 3.8 mg/dl significantly improves the efficacy of ibutilide for the chemical cardioversion of persistent atrial fibrillation and flutter in patients with rheumatic heart disease.

Limitations

Small sample size
No control arm
No long-term follow-up to assess maintenance of sinus rhythm
Did not assess reasons for variable magnesium levels achieved despite the same protocol

Cite This Study

Malviya et al. (2020) studied this question.

synapsesocial.com/papers/6a1a34a9208efea2cbef141d https://doi.org/10.1016/j.ihj.2020.07.008

Topics

Persistent AF management Atrial fibrillation

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Implication

Magnesium level was associated with ibutilide success in rheumatic AF; hypothesis-generating and requires randomized trials before practice change.

Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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