The purpose of this research study is to find out if the use of magnesium in addition to Metoprolol, a rate controlling medication that you would be offered in the Emergency Department today unrelated to this study, will help reduce your high heart rate (rapid ventricular response).
Intravenous magnesium has become a commonly utilized agent in the treatment of cardiac arrhythmias as an adjunct therapy to rate and rhythm control medications, such as its use in atrial fibrillation or atrial flutter with rapid ventricular response (AFF RVR). Though its benefit in the treatment of AFF RVR has been well documented, a consensus on the optimal dosing of magnesium has yet to be achieved. Only one randomized, controlled, double-blinded study has investigated the optimal dosing of magnesium. The purpose of this prospective, randomized, double-blinded study is to further evaluate the safety and efficacy of varying doses of intravenous magnesium in the treatment of atrial fibrillation or atrial flutter with rapid ventricular response. This study will use flat-dose intravenous metoprolol for rate control to minimize confounders. Additionally, this study will not require a resulted magnesium level prior to treatment in order to avoid delays in patient care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
196
Magnesium Sulfate 2g for the treatment of atrial fibrillation or atrial flutter with rapid ventricular response (AFF RVR)
Magnesium Sulfate 4g for the treatment of atrial fibrillation or atrial flutter with rapid ventricular response (AFF RVR)
The control group will receive a bolus of normal saline of the same volume and infused over 15 minutes.
Advocate Christ Medical Center Emergency Department (ACMC ED)
Oak Lawn, Illinois, United States
Ventricular rate control
Assessing ventricular rate control within the first 2 hours of intravenous magnesium administration as defined as a ventricular rate of \< 120 beats per minute.
Time frame: Within the first 2 hours of intravenous magnesium administration
Mean change in heart rate
Mean change in heart rate after the administration of magnesium sulfate
Time frame: up to 24 hours after magnesium infusion
Incidence of hypotension
Systolic blood pressure \< 90 or MAP \< 65
Time frame: At 1 and 2 hours after magnesium administration
Incidence of bradycardia
Heart rate \< 60 beats per minute
Time frame: At 1 and 2 hours after magnesium administration
Mean time to achieve goal heart rate
Mean time to achieve goal heart rate at 2 hours
Time frame: at 2 hours
Rate of conversion
Rate of conversion to normal sinus rhythm
Time frame: 2 hours after administration of magnesium
Clinical need for rescue medication administration
Dose of rescue medications given (magnesium and metoprolol)
Time frame: 2 hours from metoprolol administration
Mean change in heart rhythm
Mean change in heart rhythm after the administration of magnesium sulfate
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: up to 24 hours after magnesium infusion
Clinical need for rescue medication administration
Route of rescue medications given (magnesium and metoprolol)
Time frame: 2 hours from metoprolol administration