Review: magnesium is effective and safe for acute management of rapid atrial fibrillation.

M e t h o d s Data sources: MEDLINE, old MEDLINE, EMBASE/Excerpta Medica, CENTRAL, Web of Science, ISI Proceedings, Biosis Previews, CINAHL, and HealthSTAR (all to June 2005); abstracts from scientific meetings in the past 10 years; and reference lists. Study selection and assessment: Randomized controlled trials (RCTs) that compared intravenous magnesium with routine care, placebo, or antiarrhythmic drugs in adults with chronic or paroxysmal AF and rapid ventricular rate. Studies of patients with postoperative AF were excluded. 9 RCTs met the selection criteria. 8 RCTs (n = 476, range of mean ages 56 to 73 y) that compared magnesium with placebo, verapamil, diltiazem, amiodarone, or ajmaline were included in the meta-analysis; 1 RCT (n = 86) was excluded because most patients had rheumatic heart disease and mean age (38 y) was much younger than in the other trials. Total dose of magnesium ranged from 1.2 to 10 g. Quality assessment of individual trials was based on the 5-point Jadad scale (4 RCTs had scores ≥ 3). Outcomes: Success in achieving rate control (< 90 or 100 beats/min) or rhythm control measured at ≤ 24 hours (median 5 h); time to response; and adverse events.