Letters
Magnesium is underused in acute atrial fibrillation
EDITOR,--In their series on atrial fibrillation Gregory Y H Lip and colleagues have mainly concentrated on the management of chronic atrial fibrillation.1 We wish to draw attention to the problem of acute atrial fibrillation and other atrial tachyarrhythmias in critical illness and to the role of magnesium in the treatment of these conditions.Atrial arrhythmias commonly occur in critical illness; causes include treatment with inotropes, electrolyte imbalances, and hypoxia. Unfortunately, the correction of these abnormalities may not result in reversion to sinus rhythm, and in this situation magnesium is helpful. Magnesium is an important cofactor in the myocardial NaKATPase enzyme, which regulates electrical activity in the heart.2 3 Treatment with magnesium may correct rhythm disturbances in patients with both low and normal magnesium concentrations.2 3 Its efficacy in ventricular arrhythmias has been well documented.4 It is less commonly recognised that magnesium may also be used to correct supraventricular arrhythmias5 and has been shown to be superior to amiodarone in treating atrial tachyarrhythmias in critically ill patients.3 Magnesium is a relatively safe drug,2 provided that patients are observed for signs of toxicity and the serum concentration is monitored.
It is our impression that magnesium is underused; should we not use it more widely?
Senior house officer in medicine Senior house officer in medicine Consultant in intensive care and anaesthesia Intensive Care Unit, Hope Hospital, Salford M6 8HD
Daniel Dietch, Andrew Wilson, Anthony Thomas
- Lip GYH, Beevers DG, Coope JR. Atrial fibrillation in general and hospital practice. BMJ 1996;312:175-8. (20 January.) [And previous issues.]
[Free Full Text] - McLean RM. Magnesium and its therapeutic uses: a review. Am J Med 1994;96:63-76. [Medline]
- Moran JL, Gallagher J, Peake SL, Cunningham DN, Salagaras M, Leppard P. Parenteral magnesium sulphate versus amiodarone in the therapy of atrial tachyarrythmias: a prospective, randomised study. Crit Care Med 1995;23:1816-24. [Medline]
- Tzivoni D, Keren A. Suppression of ventricular arrythmias by magnesium. Am J Cardiol 1990;65:1397-9. [Medline]
- Wesley RC, Haines DE, Lerman BB, DiMarco JP, Crampton RS. Effect of intravenous magnesium sulphate on supraventricular tachycardia. Am J Cardiol 1989;63:1129-31. [Medline]
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