Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomized controlled trials.
BACKGROUND
Magnesium supplementation may reduce the incidence of arrhythmias, which often occur after cardiac surgery; however, recent findings of the effectiveness of magnesium prophylaxis have yielded discrepant results.


METHODS
We searched electronic databases for randomized controlled trials of magnesium for the prevention of arrhythmias after cardiac surgery. The primary outcomes comprised the incidence of supraventricular and ventricular arrhythmias, and the secondary outcomes comprised serum magnesium concentration, length of hospital stay, myocardial infarction, and mortality. Effect sizes were estimated using a random-effects model.


RESULTS
Seventeen trials (n=2069 patients) met the inclusion criteria. Pooled serum magnesium concentration at 24 hours after surgery in the treatment group was significantly higher than that in the control group (weighted mean difference=0.45 mmol/L [1.1 mg/dL]; 95% confidence interval [CI]: 0.30 to 0.59 mmol/L [0.7 to 1.4 mg/dL]; P <0.001). Magnesium supplementation reduced the risk of supraventricular arrhythmias (relative risk [RR]=0.77; 95% CI: 0.63 to 0.93; P=0.002) and ventricular arrhythmias (RR = 0.52; 95% CI: 0.31 to 0.87; P <0.0001), but had no effect on the length of hospital stay (weighted mean difference=-0.28 days; 95% CI: -0.70 to 1.27 days; P=0.48), the incidence of perioperative myocardial infarction (RR=1.03; 95% CI: 0.52 to 2.05; P = 0.99), or mortality (RR=0.97; 95% CI: 0.43 to 2.20; P=0.94).


CONCLUSIONS
Administration of prophylactic magnesium reduced the risk of supraventricular arrhythmias after cardiac surgery by 23% (atrial fibrillation by 29%) and of ventricular arrhythmias by 48%. Supplementation had no notable benefit with respect to length of hospitalization, incidence of myocardial infarction, or mortality.
Shiga
Toshiya
T
Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan. QZX02115@nifty.com
Wajima
Zen'ichiro
Z
Inoue
Tetsuo
T
Ogawa
Ryo
R
D001145:Arrhythmias, Cardiac / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D015982:Bias; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D015987:Effect Modifier, Epidemiologic; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008274:Magnesium / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D011322:Primary Prevention / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D008274:Magnesium