Elona Dado¹, Edvin Dado², Juliana Karanxha³, Cory Greguske⁴, Elizana Zaimi Petrela⁵, Efrosina Kajo⁶, Mrunal Teja Chinthapalli M⁷, Edlira Horjeti⁸, Fjolla Hyseni⁹, Sepideh Jahanian¹⁰, Blina Abdullahu¹¹, Mohammad Abubaker SIDDIQUE¹² and Juna Musa¹³*

¹Cardiologist, Hygea Hospital Tirana, Albania
²Cardiologist, Faculty of Medicine, UMT, /"UHC " Mother Teresa”, Tirana, Albania
³Cardiologist, American Hospital 3. Tirana, Albania
⁴Department of Cardiology St Elizabeth”s Medical Center Boston, USA
⁵Professor of Medicine, UMT, Faculty of Medicine/ UHC "Mother TERESA" Tirana, Albania
⁶Professor of Medicine, Institution (Current Position): UMT, Faculty of Medicine, Tirana, Albania
⁷Department of Endocrinology Diabetes and Nutrition Mayo Clinic Rochester Minnesota, USA
⁸Research Fellow Department of Urology Mayo Clinic Rochester Minnesota, USA
⁹PhD Candidate NYU Langone Medical Center New York City, USA
¹⁰Department of Anesthesiology Mayo Clinic Rochester Minnesota, USA
¹¹Mother Teresa Hospital Tirane, Albania
¹²Northeast Medical College and Hospital Sylhet, Bangladesh
¹³Department of Endocrinology Diabetes and Nutrition Mayo Clinic Rochester Minnesota, USA

*Corresponding Author: Juna Musa, Department of Endocrinology Diabetes and Nutrition, Mayo Clinic Rochester, Minnesota, USA.

Received: December 12, 2022; Published: December 29, 2022

Abstract

Objective: Atrial fibrillation (AF) is the most common arrhythmia complicating cardiac surgery and carries a high risk for significant morbidity and mortality in short and long term. Its prophylaxis remains crucial to improve outcomes. The role of magnesium administration in preventing the occurrence of AF after isolated bypass surgery is not well established. Variations of dose, timing and mode of administration have been proposed. The purpose of this study was to investigate the efficacy of 4-day postoperative intravenous magnesium supplementation on the incidence of postoperative AF.

Methods: We performed a prospective, randomized, placebo-controlled clinical study on 200 consecutive patients who underwent initial, elective, isolated on-pump coronary artery bypass surgery, to assess the role of magnesium sulfate administration for postoperative AF prevention. Patients in the treatment group received 10.3 mmol of magnesium sulfate in 100 mL of saline solution infused intravenously over 2 hours once daily for 4 consecutive days, starting immediately after surgery. There were no significant differences in the preoperative characteristics of patients.

Results: The incidence of postoperative AF was 18% in the magnesium-treated group compared with 35% in the control group (p 0.006). Absence of magnesium administration, magnesium serum levels less 2 mg/dl, age over 65, decreased ejection fraction, increased aortic cross clamping and cardiopulmonary bypass time were identified as independent risk factors for the development of AF on the multivariate logistic regression analysis. The duration of AF in the magnesium treated patients was longer than in the control group. There was a significantly higher presence of risk factors in the magnesium treated patients who developed AF compared with those who developed AF in the control group.

Conclusion: Our study indicates that postoperative 4-day supplementation of magnesium sulfate is helpful in reducing the incidence of AF after coronary surgery. For older patients, patients with reduced EF, patients with longer cardiopulmonary bypass and aortic cross clamping times, magnesium supplementation alone is inadequate for the prophylaxis of postoperative AF.

The longer duration of AF and the increased presence of risk factors in the magnesium treated patients who developed AF, supports the rationale that magnesium therapy is efficacious in the prevention of the subset of postoperative AF that is transitory and self-limited. Important advantages of magnesium therapy include the high safety profile and utility in identifying patients with the subset of AF that carries a higher risk of morbidity and mortality.

Keywords: Atrial Fibrillation (AF); Coronary Artery Bypass Grafting Surgery (CABG); Postoperative Atrial Fibrillation (POAF)

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Citation

Citation: Juna Musa., et al. “Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery with Postoperative Intravenous Magnesium Sulfate Supplementation”.Acta Scientific Medical Sciences 7.1 (2023): 122-136.

Copyright

Copyright: © 2022 Juna Musa., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.