Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#anti-arrhythmia-agents #atrial-fibrillation #humans #magnesium #treatment-outcome

Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis

Ramesh et al., 2021 | J Cardiol | Meta Analysis

Citation

Ramesh Tushar, Lee Paul Yong Kyu, ... Allencherril Joseph. Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis. J Cardiol. 2021-Nov;78(5):375-381. doi:10.1016/j.jjcc.2021.06.001

Abstract

BACKGROUND: The aim of this meta-analysis is to investigate the effectiveness of intravenous magnesium (IV Mg2+) in rate and rhythm control of rapid atrial fibrillation (AF) when administered in addition to standard-of-care for non-post-operative patients. Previous meta-analyses on this topic have demonstrated the efficacy of IV Mg2+ in achieving rate control, but not rhythm control. METHODS: Six randomized controlled trials comparing IV Mg2+ to placebo in the treatment of rapid AF were obtained from electronic databases totaling 745 patients. Outcomes were analyzed using a Mantel-Haenszel random-effects model and expressed as odds ratios (OR) for dichotomous outcomes with their 95% confidence intervals (CIs). RESULTS: Our pooled analysis showed that IV Mg2+ given in addition to standard-of-care was superior in achieving rate control (63% vs 40%; OR 2.49, 95% CI 1.80-3.45) and rhythm conversion to sinus (21% vs. 14%, OR 1.75, 95% CI 1.08-2.84) compared to standard-of-care alone. Flushing was more frequently observed in patients receiving IV Mg2+ compared to placebo (9% vs. 0.4%, OR 19.79, 95% CI 4.30-91.21). Subgroup analysis showed the superiority of a lower dose of IV Mg2+, which we designated as 5 g or lower (24% vs 13%, OR 2.10, 95% CI 1.22-3.61) compared to the higher dose (>5 g) (16% vs 13%, OR 1.23, 95% CI 0.65-2.32) in rhythm control when compared to placebo. CONCLUSIONS: IV Mg2+ administered in conjunction with standard-of-care is effective for rate control and modestly effective for restoration of sinus rhythm in rapid AF without clinically significant adverse effects.

Key Findings

Our pooled analysis showed that IV Mg2+ given in addition to standard-of-care was superior in achieving rate control (63% vs 40%; OR 2.49, 95% CI 1.80-3.45) and rhythm conversion to sinus (21% vs. 14%, OR 1.75, 95% CI 1.08-2.84) compared to standard-of-care alone. Flushing was more frequently observed in patients receiving IV Mg2+ compared to placebo (9% vs. 0.4%, OR 19.79, 95% CI 4.30-91.21). Subgroup analysis showed the superiority of a lower dose of IV Mg2+, which we designated as 5 g or lowe

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 745
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anti-Arrhythmia Agents
  • Atrial Fibrillation
  • Humans
  • Magnesium
  • Treatment Outcome

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: magnesium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09