Is IV potassium and magnesium an acute remedy for AF?
The probability of spontaneous conversion to sinus rhythm (SVC) was elevated with intravenous magnesium and potassium in sufferers with nonsustained atrial fibrillation presenting to the emergency division, a brand new registry examine exhibits.
In contrast with no remedy, administration of potassium and magnesium was related to a ten% larger charge of SVC.
The findings present that intravenous potassium and magnesium can scale back the necessity for antiarrhythmic remedy and related potential negative effects in sufferers with nonsustained atrial fibrillation, say the examine authors.
Nevertheless, they add: “The outcomes of our examine don’t have any direct implications for scientific apply within the administration of sufferers with AF or AF [atrial flutter] in ED. These findings are purely exploratory and speculation producing, however may probably present a rationale for an acceptable potential trial.”
The examine was printed on-line October 19 in JAMA Open Community.
“Atrial fibrillation (AF) is turning into an growing burden on well being care methods worldwide attributable to an growing older inhabitants,” write Filippo Cacioppo, MD, and colleagues from the Medical College of Vienna, Vienna, Austria.
“Pharmacological and electrical conversion are widespread therapies in emergency departments, particularly for sufferers with extreme signs. Every intervention has sure dangers, and none is taken into account cost-effective due to frequent AF recurrences. As well as, AF typically terminates spontaneously,” Cacciopa and colleagues write.
They add that proof means that hypokalemia and hypomagnesemia contribute to the event of AF, and subsequently administration of potassium and magnesium could also be an inexpensive technique to extend SCV ranges.
To check their speculation, Cacioppo et al. carried out a registry-based cohort examine from February 6, 2009, to February 16, 2020, together with all sufferers with AF or AF presenting to their heart’s emergency division.
Throughout that point, they noticed a complete of two,546 episodes of transient AF. The median affected person age was 68 years (interquartile vary [IQR], 58 – 75 years outdated). Most had been males (n = 1411 sufferers, 55.4%).
As well as, there have been 573 episodes of non-permanent AFL. The median age of the sufferers was 68 years (IQR, 58 – 75 years), and 332 sufferers (57.9%) had been male.
Intravenous potassium and magnesium had been administered in barely greater than half (n = 1763, 56.5%) of the episodes.
The typical quantity of potassium and magnesium was delivered by way of a single 250 mL infusion bag consisting of 24 mEq of potassium and 145.8 mg of magnesium mixed with 500 mL of balanced crystalloid fluid containing 2.5 mEq of potassium and 18.2 mg of magnesium, administered for 90 minutes, the authors write.
If the affected person felt ache on the injection web site, the speed of infusion was decreased till the ache disappeared.
Conversion to sinus rhythm was thought-about spontaneous if pharmacologic rhythm management was not tried till conversion occurred; if the SVC occurred after a failed electrical connection try cardioversion; or after frequency management with beta blockers, nondihydropyridine calcium channel blockers, or digitalis glycosides, the authors state.
IV Therapy will increase the probability of SVC
The median size of keep within the emergency division was 6.4 hours (IQR, 3.9 to 11.6 hours) for sufferers with AF and 6.1 hours (IQR, 3.9 to 11.8 hours) for sufferers with AFL.
Throughout the emergency division keep, SLE occurred in 15.4% (n = 393) of AF episodes and 12.7% (n = 73) of AF episodes.
Intravenous potassium and magnesium elevated the probability of SVC in contrast with no IV potassium and magnesium in AF, however not in AF.
In episodes of AF, intravenous potassium and magnesium was related to a 19.2% elevated probability of SVC in contrast with 10.4% with out administration (odds ratio [OR], 1.98; 95% CI, 1.53 – 2.57).
In distinction, for AFL, no affiliation was noticed for the probability of SCV with potassium and magnesium administration in contrast with no administration (13.0% vs. 12.5%; OR, 1.05; 95% CI, 0.65 – 1.69) .
Not within the Guide
“It’s presently unclear whether or not administration of potassium and magnesium could also be prudent within the instant remedy of AF and AF, and though this intervention could also be widespread apply in some rehabilitative circumstances, it isn’t included in remedy suggestions in present pointers,” Cacioppa et al. they write
“Our outcomes counsel that intravenous potassium and magnesium could improve the probability of SCV in sufferers with AF who’re both hypokalemic or have plasma potassium ranges between 3.50 and three.99 mEq/L. In sufferers with AFL, nevertheless, administration of potassium and magnesium will not be related to the probability of SCV,” they write.
Cacioppo et al add that of their examine, IV administration of potassium and magnesium was related to SCV solely in sufferers with symptom onset lower than 48 hours, suggesting a time-dependent consequence. Nevertheless, they warning, “as a result of solely a restricted variety of sufferers with SCV developed signs better than or equal to 48 hours, this discovering warrants additional investigation.”
“I am somewhat skeptical about this examine,” mentioned Georgios Siros, MD, director of the arrhythmia division at Mount Sinai Queens and Mount Sinai in Brooklyn, New York. theheart.org | Medscape Cardiology.
“Atrial fibrillation is a persistent illness. The pure historical past of this illness is that at the beginning it’s paroxysmal, and in some unspecified time in the future the episodes change into extra frequent and longer. For some folks, it turns into everlasting in some unspecified time in the future,” Siros mentioned.
“Suppose I minimize my finger whereas slicing bread. I put a Band-Assist on the minimize. That does not imply I fastened it, it means I briefly helped. The atrial fibrillation on this work could be very comparable,” he mentioned. mentioned. “A affected person can have an episode, they go to the emergency room, you give them drugs and also you relieve the state of affairs briefly so the affected person would not must be hospitalized. It is easy, cheap, you get the center charge regular, not everlasting, with few negative effects besides perhaps some ache on the injection web site, nevertheless it doesn’t suggest you’ve got fastened AFib completely. as a result of it is the weekend, sure, you should utilize it as a Band-Assist,” he mentioned.
Intravenous potassium and magnesium, as proposed within the present examine, is much like a drug presently utilized in Europe known as vernakalant, Siras mentioned.
“Vernakalant is just not FDA authorized within the US. It is not meant to be a everlasting remedy for atrial fibrillation, so we have to educate the general public in regards to the limitations of what we’re doing,” he mentioned. “Vernakalant is much like IV potassium and magnesium as proven on this examine, however it’s costlier. It briefly permits folks to return to sinus rhythm, nevertheless it’s not going to be there ceaselessly, and you’ll return to everlasting AFib, so it is not magic, sadly.”
Syros emphasised that the present examine outcomes refer solely to instances paroxysmal atrial fibrillation lasting lower than 48 hours. “It is an important distinction,” he mentioned.
“For instance, a affected person who has had so much to drink and is in acute fibro the subsequent day, with what we name vacation coronary heart, could be an excellent candidate for remedy on this examine. He’s younger, with out coronary heart harm, with out diabetes, with out arterial hypertensionwith out prior a strokeso certain, assist him with potassium and magnesium, supplied he can show to us that it began inside 48 hours,” Syros mentioned.
Cacioppo et al and Syros report no related monetary relationships. Corresponding examine writer Jan Niederdeckl, MD, acquired funding for the examine.
JAMA Netw Open. 2022;5(10):e2237234. Summary
#potassium #magnesium #acute #remedy