Document Detail

Efficacy of magnesium-amiodarone step-up scheme in critically ill patients with new-onset atrial fibrillation: a prospective observational study.
MedLine Citation:
PMID:  18320707     Owner:  NLM     Status:  MEDLINE    
Amiodarone is considered a first-choice antiarrhythmic drug in critically ill patients with new-onset atrial fibrillation (AF). However, evidence supporting the use of this potentially toxic drug in critically ill patients is scarce. Magnesium sulphate (MgSO4) has shown to be effective for both rate and rhythm control, to act synergistically with antiarrhythmic drugs, and to prevent proarrhythmia. Treatment with MgSO4 may reduce the need for antiarrhythmic drugs such as amiodarone in critically ill patients with new-onset atrial fibrillation. The efficacy of a new institutional protocol was evaluated. Patients were treated with a new institutional protocol for new-onset atrial fibrillation in critically ill patients. An MgSO4 bolus (0.037 g/kg body weight in 15 minutes) was followed by continuous infusion (0.025 g/kg body weight/h). Intravenous amiodarone (loading dose 300 mg, followed by continuous infusion of 1200 mg/24 h) was given to those not responding to MgSO4 within 1 hour. Clinical response was defined as conversion to sinus rhythm or decrease in heart rate <110 beats/min. Sixteen of the 29 patients responded to MgSO4 monotherapy, whereas the addition of amiodarone was needed in 13 patients. Median (range) time until conversion to sinus rhythm after MgSO4 was 2 (1-45) hours. Median (range) conversion time in patients requiring amiodarone was 4 (2-78) hours, and median (range) conversion time in all patients was 3 (1-78) hours. The 24-hour conversion rate was 90%. Relapse atrial fibrillation was seen in 7 patients. The magnesium-amiodarone step-up scheme reduces the need for amiodarone, effectively converts new-onset atrial fibrillation into a sinus rhythm within 24 hours, and seems to be safe in critically ill patients.
Mengalvio E Sleeswijk; Jaap E Tulleken; Trudeke Van Noord; John H J M Meertens; Jack J M Ligtenberg; Jan G Zijlstra
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of intensive care medicine     Volume:  23     ISSN:  0885-0666     ISO Abbreviation:  J Intensive Care Med     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-03-05     Completed Date:  2008-04-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610344     Medline TA:  J Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-6     Citation Subset:  IM    
Intensive & Respiratory Care Unit, Department of Internal Medicine, University of Groningen, Groningen, The Netherlands.
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MeSH Terms
Amiodarone / administration & dosage*
Anti-Arrhythmia Agents / administration & dosage*
Atrial Fibrillation / drug therapy*
Critical Illness*
Drug Synergism
Drug Therapy, Combination
Intensive Care Units
Magnesium Sulfate / administration & dosage*
Prospective Studies
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone; 7487-88-9/Magnesium Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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