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Ann Thorac Surg 2004;77:824-830
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

The efficacy of supplemental magnesium in reducing atrial fibrillation after coronary artery bypass grafting

^a Southern Illinois University School of Medicine, Springfield, IL, USA
^b Prairie Cardiovascular Consultants, Springfield, IL, USA
^c University of Illinois–Springfield, Springfield, Illinois, USA

Accepted for publication August 21, 2003.

^* Address reprint requests to Dr Hazelrigg, Division of Cardiothoracic Surgery, SIU School of Medicine, 800 N. Rutledge, Room D319, PO Box 19638, Springfield, IL 62794-9638, USA.
e-mail: shazelrigg{at}siumed.edu

BACKGROUND: Atrial fibrillation after coronary artery bypass is reported from 17% to 53%. Hypomagnesemia after this surgery is considered a contributing factor.

METHODS: Two hundred-two coronary bypass patients were randomized to magnesium (n = 105) or placebo (n = 97). The experimental group received 80-mg magnesium sulfate per kilogram ideal weight in 100 mL dextrose 5% water 30 minutes preoperatively. Postoperatively, patients received 8-mg magnesium sulfate per kilogram ideal weight intravenous per hour more than 48 hours. The control group received dextrose 5% water at these intervals.

RESULTS: After the first bolus serum magnesium was experimental 4.75 mg/dL versus control 1.91 mg/dL, p less than 0.001, and remained different until postoperative day 4 (experimental 2.33 mg/dL vs control 2.26 mg/dL, p = 0.24). Atrial appendage and strap muscle were analyzed after the first bolus and after revascularization. There were no differences between groups in tissue magnesium or calcium. Urinary magnesium was elevated in the experimental (experimental 324.5 mg/24 hours, vs control 45.1 mg/24 hours, p = 0.01). Calcium excretion was higher (experimental 370 mg/24 hours vs control 186 mg/24 hours, p < 0.001) and was associated with lower serum calcium. Serum calcium was higher in the control through the fourth postoperative day. The incidence of atrial fibrillation was experimental 32 of 105 (30.5%) versus control 41 of 97 (42.3%) p = 0.08. Atrial fibrillation was different on the first postoperative day (experimental 3/105, 2.9% vs control 9/97, 9.3%), p = 0.05.

CONCLUSIONS: Overall prophylactic magnesium supplementation does not significantly reduce atrial and ventricular arrhythmias. The only significant benefit of magnesium supplementation was on the first postoperative day.

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