A Systematic Review and Meta-Analysis of Clinical Effectiveness of Intravenous Magnesium Sulphate in the Treatment of Acute Fast Atrial Fibrillation in Non-surgical Adult Patients

Atrial fibrillation (AF) is the most common heart rhythm disorder in the elderly, and it contributes significantly to patient morbidity and mortality. A variety of medications, including amiodarone, beta-blockers, and calcium channel blockers, are commonly used to manage AF. Often, intravenous magnesium (IV Mg) is used as an adjunctive therapy for rate and rhythm control; however, its efficacy in managing fast AF has been controversial, with previous meta-analyses yielding conflicting results. This meta-analysis sought to establish the effectiveness of IV Mg in the treatment of fast AF by incorporating data from a recently concluded randomised controlled trial (RCT) on the same subject. Six RCTs, including 480 patients, comparing IV Mg with placebo in the treatment of fast AF were retrieved after an extensive search of electronic databases. The Mantel-Haenszel (MH) random-effects model was used to estimate the mean effect size across all the included studies. The differences among treatment groups for nominal variables were documented as odds ratios (ORs) with 95% confidence intervals (CIs). The pooled analysis showed that IV Mg given as an adjunct to guidelines-recommended medications had a significant positive impact in achieving rate control (OR: 2.15, 95% CI: 0.98, 4.73, P = 0.03), with no substantial heterogeneity (I² = 60%) as compared to placebo. Similarly, IV Mg was superior to placebo in converting AF rhythm to sinus rhythm (OR: 1.64, 95% CI: 0.90, 2.99, P = 0.18), with moderate heterogeneity (I² = 34%). On safety profile analysis, flushing was more frequently observed in patients who were treated with IV Mg than in those who were given a placebo (OR: 14.12, 95% CI: 3.16, 63.20, P < 0.001), with no statistically significant heterogeneity detected (I² = 0%). The overall OR numerically favoured a higher risk of hypotension with IV Mg compared to placebo; however, the result did not reach statistical significance, and the CI was extremely wide. In conclusion, the meta-analysis establishes that IV Mg administered as an adjunct to the standard guidelines-recommended care is significantly effective for rate control and moderately effective for cardioverting fast AF in adult non-post-operative patients.