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Comparison of magnesium sulphate with placebo for prevention of atrial fibrillation in post Coronary Artery Bypass Grafting (CABG) patients

Adnan Tahir, Faridulah Khan, Naseer Ahmed, Humaira Achakzai, Marib Ghulam Rasool Malik, Azam Jan

Background: Postoperative Atrial Fibrillation (AF) is the most common complication that develops after cardiovascular surgery and is associated with adverse outcomes. Magnesium is an essential element in the body, which is required as a cofactor for over 300 enzymatic reactions and reduced levels of magnesium in the blood have been found related with an increased risk of AF, both in ambulatory setting and after cardiac surgeries. Our study was aimed at determining the role of prophylactic magnesium sulphate in preventing postoperative AF in subjects undergoing Coronary Artery Bypass Graft (CABG).

Objective: To compare efficacy of magnesium sulphate with placebo for prevention of atrial fibrillation after coronary artery bypass surgery.

Duration: 6 months (07-03-2018 to 06-09-2018).

Setting: Department of Cardiac surgery, Cardiac Center PIMS Islamabad.

Subjects and methods: In the present study, we enrolled a total of one hundred and twenty-eight (n=128) patients of both gender between ages 50-70 years who were planned for coronary artery bypass surgery. All the patients were randomized by lottery method into group A, who were given intravenous injection of 200 mEq MgSO4 in 100 ml of normal saline/day for 03 days and group B, who were given intravenous injection of 100 ml of normal saline only for 03 days. All the patients had continuous cardiac monitoring performed for 72 hours to observe for occurrence of AF. Occurrence of postoperative AF was compared in both groups by applying chi-square test, a p-value of <0.05 was considered as significant.

Results: Postoperative AF was observed in 12.5% (n=8/64) patients in group A while it was observed in 45.3% (n=29/64) patients in group B (p=0.001). When stratified for age and gender magnesium sulphate was found more effective in preventing postoperative AF in younger males (p=0.001).

Conclusion: In the present study, postoperative AF was developed in significantly lesser number of patients who received prophylactic magnesium sulphate as compared to placebo group. Magnesium sulphate was found more effective in preventing postoperative AF among younger males.