Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 7 Issue 1

Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery with Postoperative Intravenous Magnesium Sulfate Supplementation

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)

References

  1. Greenberg JW., et al. “Postoperative atrial fibrillation following cardiac surgery: a persistent complication”. European Journal of Cardio-Thoracic Surgery4 (2017): 665-672.
  2. Melby S J., et al. “A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery”. The Journal of Thoracic and Cardiovascular Surgery 149 (2015): 886-892.
  3. Aranki SF., et al. “Predictors of atrial fibrillation after coronary artery surgery: current trends and impacts on hospital resources”. Circulation 94 (1996): 390-397.
  4. Funk M., et al. “Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery”. American Journal of Critical Care 12 (2003): 424-433.
  5. Kalman JM., et al. “Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation”. The Annals of Thoracic Surgery 60 (1995): 1709-1715.
  6. Reed G III., et al. “Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits”. The New England Journal of Medicine 319 (1988): 1246-1250.
  7. Roach GW., et al. “Adverse cerebral outcomes after coronary bypass surgery”. The New England Journal of Medicine 335 (1996): 1857-1863.
  8. Bucerius J., et al. “Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery”. The Journal of Thoracic and Cardiovascular Surgery 127 (2004): 57-64.
  9. Saxena A., et al. “Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients)”. American Journal of Cardiology 109 (2012): 219-225.
  10. Kaplan M., et al. “Intravenous magnesium sulfate prophylaxis for atrial fibrillation after coronary artery bypass surgery”. The Journal of Thoracic and Cardiovascular Surgery 125 (2003): 344-352.
  11. O’Neal JB., et al. “Effect of preoperative beta-blocker use on outcomes following cardiac surgery”. American Journal of Cardiology 120 (2017): 12931297.
  12. Daoud EG., et al. “Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery”. The New England Journal of Medicine25 (1997): 1785-1791.
  13. Buckley MS., et al. “Amiodarone prophylaxis for atrial fibrillation after cardiac surgery: meta analysis of dose response and timing of initiation”. Pharmacotherapy 27 (2007): 360-368.
  14. Fanning WJ., et al. “Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting”. The Annals of Thoracic Surgery3 (1991): 529-533.
  15. Colquhoun IW., et al. “Arrhythmia prophylaxis after coronary artery surgery. A randomised controlled trial of intravenous magnesium chloride”. European Journal of Cardio-Thoracic Surgery10 (1993): 520-523.
  16. Parikka H., et al. “The influence of intravenous magnesium sulphate on the occurrence of atrial fibrillation after coronary artery by-pass operation”. European Heart Journal2 (1993): 251-258.
  17. Speziale G., et al. “Arrhythmia prophylaxis after coronary artery bypass grafting: regimens of magnesium sulfate administration”. Thoracic and Cardiovascular Surgery 48 (2000): 22-26.
  18. Shakerinia T., et al. “Magnesium in cardioplegia: is it necessary?”. Canadian Journal of Surgery5 (1996): 397-400.
  19. Jensen BM., et al. “Magnesium substitution and postoperative arrhythmias in patients undergoing coronary artery bypass grafting”. Scandinavian Cardiovascular Journal 5 (1997): 265-269.
  20. Treggiari-Venzi MM., et al. “Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery”. British Journal of Anaesthesia5 (2000): 690-695 JO.
  21. Solomon AJ., et al. “The combination of propranolol and magnesium does not prevent postoperative atrial fibrillation”. The Annals of Thoracic Surgery1 (2000): 126-129.
  22. Hazelrigg SR., et al. “The efficacy of supplemental magnesium in reducing atrial fibrillation after coronary artery bypass grafting”. The Annals of Thoracic Surgery3 (2004): 824-830.
  23. Lancaster TS., et al. “Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis”. The Annals of Thoracic Surgery 102 (2016): 1181-1189.
  24. Toraman F., et al. “Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting”. The Annals of Thoracic Surgery 72 (2001): 1256-1261.
  25. Aglio LS., et al. “Hypomagnesemia is common following cardiac surgery”. The Journal of Cardiothoracic and Vascular Anesthesia 5 (1991): 201-208.
  26. Wilkes NJ., et al. “Correction of ionized plasma magnesium during cardiopulmonary bypass reduces the risk of postoperative cardiac arrhythmia”. Anesthesia and Analgesia 95 (2002): 828-834.
  27. Satur CMR., et al. “Magnesium flux caused by coronary artery bypass operation: three patterns of deficiency”. The Annals of Thoracic Surgery 58 (1994): 1674-1678.
  28. Yang Q., et al. “Protective effect of magnesium on the endothelial function mediated by endothelium-derived hyperpolarizing factor in coronary arteries during cardioplegic arrest in a porcine model”. The Journal of Thoracic and Cardiovascular Surgery 124 (2002): 361-370.
  29. Hindricks G., et al. “2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): )”. European Heart Journal 42 (2020): 373-498.
  30. Frendl G., et al. “2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures”. The Journal of Thoracic and Cardiovascular Surgery 148 (2014): e153-e193.
  31. Kerwin M., et al. “New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and metaanalysis”. Clinical Cardiology 43 (2020): 928-934.
  32. Benedetto U., et al. “Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery”. Circulation 142 (2020): 1320-1329.
  33. Lee SH., et al. “New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft”. American Heart Journal 167 (2014): 593-600.e591.
  34. Lin MH., et al. “Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality”. Stroke 50 (2019): 1364-1371.
  35. Phan K., et al. “Newonset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta analysis”. European Journal of Cardio-Thoracic Surgery 48 (2015): 817-824.
  36. Kaw R., et al. “Short-and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis”. The Journal of Thoracic and Cardiovascular Surgery 141 (2011): 1305-1312.
  37. Saatvedt K., et al. “Is atrial fibrillation caused by extracorporeal circulation?”. The Annals of Thoracic Surgery 68 (1999): 931-933.
  38. Mitchell BL and the CCS Atrial Fibrillation Guidelines Committee Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010. “Prevention and Treatment of Atrial Fibrillation Following Cardiac Surgery”. Canadian Journal of Cardiology 27 (2011): 91-97.
  39. Klevay LM and Milne DB. “Low dietary magnesium increases supraventricular ectopy”. American Journal of Clinical Nutrition3 (2002): 550-554.
  40. Millane TA., et al. “Myocardial magnesium depletion associated with prolonged hypomagnesemia: a longitudinal study in heart transplant recipients”. Journal of the American College of Cardiology4 (1992): 806-812.
  41. Dunning J., et al. “Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery”. European Journal of Cardio-thoracic Surgery 30 (2006): 852-872.
  42. Shiga T., et al. “Magnesium prophylaxis for arrhythmia after cardiac surgery: a meta-analysis of randomised controlled trials”. American Journal of Medicine 117 (2004): 325-333.
  43. Miller S., et al. “Effects of Magnesium on atrial fibrillation after cardiac surgery: a meta-analysis”. Heart 91 (2005): 618-623.
  44. Alghamdi AA., et al. “Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis”. Journal of Cardiac Surgery 20 (2005): 293-299.
  45. Burgess D C., et al. “Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis”. European Heart Journal 27 (2006): 2846-2857.
  46. Henyan NH., et al. “Impact of intravenous magnesium on post-cardiothoracic surgery atrial fibrillation and length of hospital stay: a meta-analysis”. The Annals of Thoracic Surgery 80 (2005): 2402-2406.
  47. , et al. “Intravenous magnesium prevents atrial fibrillation after coronary artery bypass grafting: a metaanalysis of 7 double-blind, placebo-controlled, randomized clinical trials”. Gu et al. Trials (2012).
  48. Arsenault KA., et al. “Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery”. Cochrane Database System Review (2013): CD003611.
  49. Fairley JL., et al. “Magnesium status and magnesium therapy in cardiac surgery: a systematic review and meta-analysis focusing on arrhythmia prevention”. Journal of Critical Care 42 (2017): 69-77.
  50. Chaudhary R., et al. “Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials”. Journal of Atrial Fibrillation1 (2019).

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.




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