Atrial fibrillation and QTc prolongation associated with hypokalemia and hypomagnesemia: a case report

A trial fibrillation (AF) is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion, each carrying specific risks.AF may resolve spontaneously, but often recurs, making a "watch-andwait" strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.Additionally, research has shown that hypomagnesemia and hypokalemia contribute to AF development.Thus, potassium and magnesium supplementation may be a rational strategy to enhance spontaneous sinus rhythm conversion rates. [1,2] 70-year-old female patient was brought to the emergency department by her relatives due to fatigue and altered consciousness.History revealed that she had diarrhea for several days and had been unable to eat properly.Her medical history included high blood pressure and diabetes mellitus.On admission, the patient appeared ill, with a lethargic mental state.Vital signs were as follows: pulse rate of 120 beats/min, body temperature of 36.2 C, blood pressure of 110/70 mmHg, respiratory rate of 22 breaths/min, and oxygen saturation of 96%.Blood glucose was measured at 312 mg/dL.Cardiovascular examination revealed an irregular tachycardia.Neurological examination showed a Glasgow Coma Scale score of 12, without any focal neurological deficits or neck stiffness.Electrocardiogram (ECG), venous blood gas analysis, and laboratory parameters were assessed.ECG revealed an irregular rhythm with a high ventricular response, indicating AF.The ventricular rate was 131 beats/min, QRS duration 92 ms, and QTc interval of 491 ms (Figure 1).Arterial blood gas analysis showed pH of 7.47, HCO 3 of 19%, lactate of 2.1 mmol/L, base excess of 3.4, and calcium of 1.09 mmol/L.Intravenous access was esta-