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Effect of intravenous magnesium on heart rate and heart rate variability in patients with chronic atrial fibrillation

      Atrial fibrillation (AF) increases the risk for thromboembolism and mortality, and may cause disabling symptoms. Loss of atrial contraction results in a 20% to 30% decrease in left ventricular filling, and may thereby contribute to congestive heart failure. In addition, the irregular RR intervals in AF have detrimental effects on cardiac hemodynamics.
      • Naito M.
      • David D.
      • Michelson E.L.
      • Schaffenburg M.
      • Dreifus L.S.
      The hemodynamic concequences of cardiac arhythmias evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model.
      Irregular RR intervals, independent of heart rate, results in decreased cardiac output, increased pulmonary wedge pressure, increased right atrial pressure,
      • David M.C.
      • Vance J.P.
      • Andrew E.E.
      • Neal K.
      Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation.
      and an independent negative impact on left ventricular peak ejection velocity.
      • Schneider F.
      • David T.M.
      • Shick E.C.
      • Gaasch W.H.
      Interval-dependent changes in left ventricular contractile state in lone atrial fibrillation and in atrial fibrillation associated with coronary artery 0disease.
      In patients with AF, reduced rate variability has been reported with pindolol,
      • James M.A.
      • Channer K.S.
      • Papouchado M.
      • Rees J.R.
      Improved control of atrial fibrillation with combined pindolol and digoxin therapy.
      and to some extent with verapamil,
      • Channer K.S.
      • Papouchado M.
      • James M.A.
      • Pitcher D.W.
      Towards improved control of atrial fibrillation.
      whereas digoxin seems to have only a modest effect on rate variability.
      • Hnatkova K.
      • Murgatroyd F.D.
      • Cemm A.J.
      • Malik M.
      Effect of digoxin on the ventricular rate variability during paroxysmal atrial fibrillation.
      There are some reports on electrophysiologic effects of magnesium (Mg) in patients with sinus rhythm.
      • Kulick D.L.
      • Hong R.
      • Ryzen E.
      • Rude R.K.
      • Rubin J.N.
      • Elkayam U.
      • Rahimtoola S.H.
      • Bhandari A.K.
      Electrophysiologic effects of intravenous magnesium in patients with normal conduction systems and no clinical evidence of cardiac disease.
      ,
      • DiCarlo L.A.
      • Morady F.
      • Buitleir M.
      • Krol R.B.
      • Schurig L.
      • Annesley T.M.
      Effects of magnesium sulfate on cardiac conduction and refractoriness in humans.
      ,
      • Perticone F.
      • Ceravalo R.
      • Costa R.
      • Mattioli P.L.
      Electrophysiologic effects of magnesium sulfate infusion in patients with cardiac conduction defects.
      In these studies Mg, given intravenously, resulted in prolongation of the sinoatrial, intraatrial, suprahisian, infrahisian, and atrioventricular (AV) conduction time. There are conflicting results as to whether Mg is effective in terminating reentrant AV supraventricular tachycardia and atrial flutter/fibrillation.
      • Sager P.
      • Widehorn J.
      • Petersen R.
      • Leon C.
      • Ryzen E.
      • Rude R.
      • Rahimtoola S.
      • Bhandari A.
      Prospective evaluation of parenteral magnesium sulfate in the treatment of patients with reentrant AV supraventricular tachycardia.
      ,
      • Viskin S.
      • Belhassen B.
      • Sheps D.
      • Laniado S.
      Clinical and electrophysiologic effects of magnesium sulfate on paroxysmal supraventricular tachycardia and comparison with adenosine triphospate.
      ,
      • Wesley R.C.
      • Haines D.E.
      • Lerman B.
      • Dimarco J.P.
      • Cramton R.S.
      Effect of magnesium sulfate on supraventricular tachycardia.
      ,
      • Gullestad L.
      • Birkeland K.
      • Molstad P.
      • Hoyer M.M.
      • Vanberg P.
      • Kjekshus J.
      The effect of magnesium versus verapamil on supraventricular arrhythmias.
      ,
      • Moran J.L.
      • Gallagher J.
      • Peake S.L.
      • Cunningham D.N.
      • Salagaras M.
      • Leppard P.
      Parenteral magnesium sulfate versus amiodaron in therapy of atrial tachyarrhythmias a prospective, randomized study.
      The present study in patients with chronic AF was designed to investigate (1) the effects of Mg on heart rate and rate variability, and (2) the intraindividual variation of heart rate and rate variability.
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