Review: Magnesium is effective and safe for acute management of rapid atrial fibrillation

摘要

Magnesium has several effects on the heart that may be beneficial fornpatients with rapid AF, including prolongation of the refractory periodnof the atrioventricular node. Onalan and colleagues synthesized thendata from previous studies to examine whether these biological effectsnare translated into clinically beneficial outcomes relative to placebo ornactive treatment. They used a rigorous search strategy to identify 9nRCTs and concluded that magnesium is effective and safe for the managementnof rapid AF. However, several limitations raise concerns aboutnthe strength of the conclusions. Most notably, comparing magnesiumnwith placebo when active treatments are available is of questionablenclinical relevance. Similarly, the importance of an outcome combiningnrate and rhythm control into an “overall response” is unclear. The smallnsample size of the aggregated data, wide variation in magnesiumndosages, and marked heterogeneity among trials also limit confidencenin the results. A further concern is the exclusion of a study (1), whichnfound that a calcium-channel blocker was superior to magnesium fornrate control, because of factors that were not prespecified as exclusionncriteria for the meta-analysis.