Magnesium in addition to sotalol does not influence the incidence of postoperative atrial tachyarrhythmias after coronary artery bypass surgery.
OBJECTIVE
Postoperative atrial tachyarrhythmias (POATs) after coronary artery bypass grafting (CABG) are reported in 11% to 40% of patients. Several etiologic factors are mentioned. Prophylactic intervention with sotalol is reported to reduce the incidence of POAT. The authors studied the effect of magnesium chloride (MgCl2) in addition to sotalol in the prevention of POAT.


METHODS
Prospective, randomized, double-blinded, placebo-controlled trial.


METHODS
Single center.


METHODS
After institutional approval and written informed consent, patients undergoing CABG with use of cardiopulmonary bypass were included in a prospective, randomized, placebo-controlled double-blind study. In 74 patients, intravenous MgCl2, 50 mmol/24 hours, was continuously administered after the induction of anesthesia during 36 hours; 73 patients received placebo. In both groups, sotalol orally was started 16 to 24 hours after CABG. The incidence and duration of in-hospital POAT were evaluated.


RESULTS
A total of 147 patients could be evaluated: in the magnesium-treated group (n = 74), 25 patients developed POAT (34%) and in the placebo group (n = 73) 19 patients (26%) (p = 0.36). There was no statistically significant difference in duration of POAT between the groups. In the magnesium-treated group, 9 patients experienced serious bradyarrhythmias (12%), and in the placebo group no serious bradyarrhythmias were observed (p = 0.003). There was no mortality in either group.


CONCLUSIONS
These results show that MgCl(2), in addition to sotalol, is not more effective than sotalol alone in the prevention of tachyarrhythmias after CABG. The data showed that this combination may also induce serious bradyarrhythmias.
Geertman
Hans
H
Department of Cardiology, Cardiothoracic Anesthesia and Cardiac Surgery, Isala Clinics, Weezenlanden Hospital, Zwolle, The Netherlands. v.derks@diagram-zwolle.nl
van der Starre
Peter J A
PJ
Sie
Hauw T
HT
Beukema
Willem P
WP
van Rooyen-Butijn
Michelle
M
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D001282:Atrial Flutter / Q000209:etiology / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006325:Heart Atria; D006801:Humans; D015636:Magnesium Chloride / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013015:Sotalol / Q000008:administration & dosage*; D013610:Tachycardia / Q000209:etiology / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D015636:Magnesium Chloride; D013015:Sotalol