Intravenous Magnesium Infusion in Patients Undergoing Cardioversion of Atrial Fibrillation Trial
| Status: | Completed |
|---|---|
| Conditions: | Atrial Fibrillation |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/5/2014 |
| Start Date: | April 2012 |
| End Date: | June 2013 |
| Contact: | Anne B Curtis, MD |
| Email: | abcurtis@buffalo.edu |
| Phone: | 716-859-4831 |
The proposed study is designed to evaluate the effect of an intravenous infusion of
magnesium sulfate in facilitating successful cardioversion of atrial fibrillation and in
decreasing the energy threshold (in J) required for successful cardioversion of atrial
fibrillation into sinus rhythm.
magnesium sulfate in facilitating successful cardioversion of atrial fibrillation and in
decreasing the energy threshold (in J) required for successful cardioversion of atrial
fibrillation into sinus rhythm.
Patients with atrial fibrillation may suffer from disabling symptoms such as palpitations,
shortness of breath or worsening heart failure. In such patients, it may be beneficial to
convert their rhythm to sinus rhythm. Cardioversion can be achieved either pharmacologically
or electrically. Pharmacological cardioversion is less successful acutely than electrical
cardioversion and may be associated with complications such as prolongation of the QT
interval and torsades de pointes (polymorphic ventricular tachycardia). Thus, cardioversion
is most often accomplished electrically, using biphasic synchronized shocks of 75-200
Joules. Biphasic electrical cardioversion in atrial fibrillation has shown to be successful
(i.e., converting to sinus rhythm) about 88% of the time, on average. The success rate
appears to largely depend upon the duration of the arrhythmia and the presence and severity
of structural heart disease.
In this study, we will evaluate the effect of intravenous magnesium sulfate on the success
rate of electrical cardioversion, and also assess its effect in decreasing the energy levels
needed for successful cardioversion. If the study is successful, we will have shown that a
simple and inexpensive intervention can increase the success rate of electrical
cardioversion, increasing the proportion of patients who can be restored to sinus rhythm. In
addition, success with lower energy levels may improve the safety of cardioversion, as high
energy levels are more likely to be associated with side effects
shortness of breath or worsening heart failure. In such patients, it may be beneficial to
convert their rhythm to sinus rhythm. Cardioversion can be achieved either pharmacologically
or electrically. Pharmacological cardioversion is less successful acutely than electrical
cardioversion and may be associated with complications such as prolongation of the QT
interval and torsades de pointes (polymorphic ventricular tachycardia). Thus, cardioversion
is most often accomplished electrically, using biphasic synchronized shocks of 75-200
Joules. Biphasic electrical cardioversion in atrial fibrillation has shown to be successful
(i.e., converting to sinus rhythm) about 88% of the time, on average. The success rate
appears to largely depend upon the duration of the arrhythmia and the presence and severity
of structural heart disease.
In this study, we will evaluate the effect of intravenous magnesium sulfate on the success
rate of electrical cardioversion, and also assess its effect in decreasing the energy levels
needed for successful cardioversion. If the study is successful, we will have shown that a
simple and inexpensive intervention can increase the success rate of electrical
cardioversion, increasing the proportion of patients who can be restored to sinus rhythm. In
addition, success with lower energy levels may improve the safety of cardioversion, as high
energy levels are more likely to be associated with side effects
Inclusion Criteria:
- Patient with new onset Atrial fibrillation less than 48 hours after onset undergoing
electrical cardioversion.
- Patients with atrial fibrillation longer than 48 hours on warfarin with documented
therapeutic INR levels >2 for at least 3 weeks prior to the cardioversion, or been on
dabigatran for 3 weeks, or a transesophageal echocardiogram on the day of the
procedure that excludes intracardiac thrombi, undergoing electrical cardioversion.
Exclusion Criteria:
- Creatinine >2.0 mg/dl
- Potassium level less than 3.5 mmol/dl
- TSH < 0.5
- Magnesium levels >3.0 mg/dl
- Urgent need for cardioversion (e.g., hemodynamic instability, unstable angina,
pulmonary edema)
- Patients with recent (less than 6 weeks) acute myocardial infarction
- Patients post-cardiac surgery
- Pregnant women
- Patients who are being treated with antiarrhythmic drugs who have received less than
five doses of the drug. For amiodarone, patients who have received less than three
weeks prior to cardioversion are excluded.
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