Key result
IV magnesium before flecainide shows no significant cardioversion benefit over flecainide alone in acute AF.
Why the study?
Although studies suggest a role for magnesium sulfate in treating AF and it is widely used for supraventricular arrhythmias, its use in clinical practice is not standardized.
Does intravenous Magnesium Sulfate improve cardioversion rates or reduce the need for antiarrhythmics in patients with acute-onset atrial fibrillation?
Observational (n=97)
No
Does intravenous Magnesium Sulfate improve cardioversion rates or reduce the need for antiarrhythmics in patients with acute-onset atrial fibrillation?
Absolute Event Rate: 91.3% vs 80.4%
p-value: p=0.12
Intravenous magnesium sulfate may facilitate spontaneous cardioversion and reduce heart rate in acute-onset atrial fibrillation, potentially reducing the need for antiarrhythmic drugs like flecainide.
Does not support routine magnesium addition to flecainide; leaves open adjunctive benefit in acute AF pending randomized confirmation.
Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO4 infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO4 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 pts (Group A). We also found a statistical significance in the HR at the time of cardioversion between Group A (77.8 ± 19.1 bpm) and Group B (87 ± 21.7 bpm). No complications emerged. The association between MgSO4 and Flecainide has not yielded statistically significant results. However, in consideration of its high safety profile, MgSO4 administration may play a role in ED cardioversion of acute onset AF, reducing the need for antiarrhythmic medications and electrical cardioversion procedures, relieving symptoms reducing heart rate, and reducing the length of stay in the ED.
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Gilardi et al. (2022) conducted an observational in Acute-Onset Atrial Fibrillation (n=97). Intravenous Magnesium Sulfate (MgSO4) vs. No MgSO4 infusion (Flecainide only) was evaluated on Overall cardioversion rate within 6 hours (p=0.12). Intravenous magnesium sulfate administration prior to flecainide resulted in a 91.3% overall cardioversion rate compared to 80.4% with flecainide alone in patients with acute-onset atrial fibrillation, though the difference was not statistically significant (p=0.12).
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