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Ventricular arrhythmia suppression by magnesium treatment after coronary artery bypass surgery

  • Original Articles
  • Published:
International Journal of Angiology

Abstract

Ventricular arrhythmias occur frequently shortly after coronary artery bypass grafting (CABG), and their occurrence coincides with the postoperative decline in serum magnesium (Mg) levels. To examine if this decline causes ventricular arrhythmias and if their appearance could be reduced by intravenous Mg administration, 140 consecutive CABG patients were randomized to receive 70 mmol of Mg sulphate (N=69) or placebo (N=71) over two days. Serum Mg concentration fell to 0.77 mmol/l in the control group but rose to 1.09 mmol/l in the Mg group (p<0.001). On 48 h Holter, the number of ventricular premature complexes (VPC) on the third postoperative day was reduced in the Mg group (4±5 vs 12±21 VPCs/h;p<0.05) and the incidence of complex ventricular arrhythmias (Lown grade 2–5) was significantly diminished (19% vs 41% of the patients;p<0.05). In multivariate analysis, high risk ventricular arrhythmias (repetitive polymorphic ventricular complexes, couplets, R-on-T complexes or operative tachycardia) were independently predicted by high number of bypassed vessels (p=0.01), poor NYHA functional class (p=0.06), preoperative diuretic use (p=0.07), and low postoperative Mg levels (p=0.08). In conclusion, correction of the postoperative decline in serum Mg concentration decreases the occurrence of early VPCs and complex ventricular arrhythmias. Patients with extensive underlying coronary artery disease and prior diuretic therapy appear to benefit greatest from Mg treatment.

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References

  1. Michelson EL, Morganroth J, MacVaugh HI (1979) Postoperative arrhythmias after coronary artery and cardiac valvular surgery detected by long-term electrocardiographic monitoring. Am Heart J 97:442–448.

    Google Scholar 

  2. DeSoyza N, Thenabadu PN, Murphy ML, Kane JJ, Doherty JE (1981) Ventricular arrhythmia before and after aorto-coronary bypass surgery. Int J Cardiol 1:123–130.

    Google Scholar 

  3. Topol EJ, Lerman BB, Baughman KL, Platia EV, Griffith LSC (1986) De novo refractory ventricular tachyarrhythmias after coronary revascularization. Am J Cardiol 57:57–59.

    Google Scholar 

  4. DeSoyza N, Murphy M, Bisset J, Kans J, Doherty J (1978) Ventricular arrhythmia in chronic stable angina pectoris with surgical or medical treatment. Ann Intern Med 89:10–14.

    Google Scholar 

  5. Ferraris VA, Ferraris SP, Gilliam HS, Berry WR (1991) Predictors of postoperative ventricular dysrhythmias: a multivariate study. J Cardiovasc Surg 32:12–20.

    Google Scholar 

  6. Rubin DA, Nieminski KE, Monteferrante JC, Magee T, Reed GE, Herman MV (1985) Ventricular arrhythmias after coronary artery by-pass graft surgery: incidence, risk factors, and long-term prognosis. J Am Coll Cardiol 6:307–310.

    Google Scholar 

  7. Butler J, Harriss R, Sinclair M, Westaby S (1993) Amiodarone prophylaxis for tachycardias after coronary artery surgery: a randomised, double blind, placebo controlled trial. Br Heart J 70:56–60.

    Google Scholar 

  8. Chiolero R, Borgeat A, Fisher A (1991) Postoperative arrhythmias and risk factors after open heart surgery. Thorac Cardiovasc Surgeon 39:81–84.

    Google Scholar 

  9. Parikka H, Toivonen L, Pellinen T, Verkkala K, Järvinen A, Nieminen MS (1993) The influence of intravenous magnesium sulphate on the occurrence of atrial fibrillation after coronary artery by-pass operation. Eur Heart J 14:251–258.

    Google Scholar 

  10. Bunton RW (1983) Value of serum magnesium estimation in diagnosing myocardial infarction and predicting dysrhythmias after coronary artery bypass grafting. Thorax 38:946–950.

    Google Scholar 

  11. England MR, Gordon G, Salem M, Chernow B (1992) Magnesium administration and dysrhythmias after cardiac surgery. J Am Med Assoc 268:2395–2402.

    Google Scholar 

  12. Frane J (1985) Description and estimation of missing data. In: BMDP Statistical Software Manual, Dixon WJ, Brown MB, Engelman L, et al (eds). University of California Press: Berkeley, pp 217–234.

    Google Scholar 

  13. Tomaselli GF, Beuckelmann DJ, Calkins HG, et al (1994) Sudden cardiac death in heart failure. The role of abnormal repolarization. Circulation 90:2534–2539.

    Google Scholar 

  14. Vejlsted H, Eliassen P (1978) Postoperative serum level and urinary excretion of magnesium following heart surgery. Scand J Thor Cardiovacs Surg 12:91–94.

    Google Scholar 

  15. Chernow B, Bamberger S, Stoiko M, et al (1989) Hypomagnesemia in patients in postoperative intensive care. Chest 95:391–397.

    Google Scholar 

  16. Flink EB, Brick JE, Shane SR (1981) Alterations of long-chain free fatty acid and magnesium concentration on acute myocardial infarction. Arch Intern Med 141:441–443.

    Google Scholar 

  17. Thandroyen FT, Bellotto D, Katayama A, Hagler HK, Willerson JT, Buja LM (1992) Subcellular electrolyte alterations during progressive hypoxia and following reoxygenation in isolated neonatal rat ventricular myocytes. Circ Res 71:106–19.

    Google Scholar 

  18. Seelig M (1989) Cardiovascular consequences of magnesium deficiency and loss: pathogenesis, prevalence and manifestations—magnesium and chloride loss in refractory potassium repletion. Am J Cardiol 63:4G-21G.

    Google Scholar 

  19. Kraft LF, Katholi RE, Woods WT, James TN (1980) Attenuation by magnesium of the electrophysiologic effects of hyperkalemia on human and canine heart cells. Am J Cardiol 45:1189–1195.

    Google Scholar 

  20. White RE, Hartzell HC (1989) Magnesium ions in cardiac function. Regulator of ion channels and second messangers. Biochem Pharmacol 38:859–867.

    Google Scholar 

  21. Du Troit EF, Opie L (1992) Modulation of severity of reperfusion stunning in the isolated rat heart by agents altering calcium flux at onset of reperfusion. Circ Res 70:960–967.

    Google Scholar 

  22. Hearse DJ, Stewart DA, Braimbridge MW (1978) Myocardial protection during ischaemic cardiac arrest: the importance of magnesium in cardioplegic solutions. J Thorac Cardiovasc Surg 75:877–885.

    Google Scholar 

  23. Kirkels JH, van Echteld CJA, Ruigrok TJC (1989) Intracellular magnesium during myocardial ischemia and reperfusion: possible consequences for postischemic recovery. J Mol Cell Cardiol 21:1209–1218.

    Google Scholar 

  24. Brill A, Rochette L (1990) Prevention of reperfusion-induced ventricular arrhythmias in isolated rat heart with magnesium. Can J Physiol Pharmacol 68:694–699.

    Google Scholar 

  25. Gottlieb SS, Baruch L, Kukin ML, Bernstein JL, Fisher ML, Packer M (1990) Prognostic importance of the serum magnesium concentration in patients with congestive heart failure. J Am Coll Cardiol 16:827–831.

    Google Scholar 

  26. Sueta CA, Clarke SW, Dunlap SH, et al (1994) Effect of acute magnesium administration on the frequency of ventricular arrhythmia in patients with heart failure. Circulation 89:660–666.

    Google Scholar 

  27. Ralston MA, Murnane MR, Kelley RE, Altschuld RA, Unverferth DV, Leier CV (1989) Magnesium content of serum, circulating mononuclear cells, skeletal muscle, and myocardium in congestive heart failure. Circulation 80:573–580.

    Google Scholar 

  28. Dyckner T, Wester PO (1987) Plasma and skeletal muscle electrolytes in patients on long-term diuretic therapy for arterial hypertension and/or congestive heart failure. Acta Med Scand 222:231–236.

    Google Scholar 

  29. Ryzen E, Elkayam U, Rude RK (1986) Low blood mononuclear cell magnesium in intensive cardiac care unit patients. Am Heart J 111:475–480.

    Google Scholar 

  30. Reinhart RA, Marx JJ, Broste SK, Haas RG (1991) Myocardial magnesium: relation to laboratory and clinical variables in patients under-going cardiac surgery. J Am Coll Cardiol 17:651–656.

    Google Scholar 

  31. Ralston MA, Murnane MR, Unverferth DV, Leier CV (1990) Serum and tissue magnesium concentration in patients with heart failure and serious ventricular arrhythmias. Ann Intern Med 113:841–846.

    Google Scholar 

  32. Frustaci A, Caldarulo M, Schiavoni G, Bellocci F, Manzoli U, Cittadini A (1987) Myocardial magnesium content, histology, and antiarrhythmic response to magnesium infusion. Lancet 2:1019.

    Google Scholar 

  33. Gettes LS (1992) Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation 85(suppl I):I-70–I-76.

    Google Scholar 

  34. Gettes LS, Surawicz B, Shiue J (1962) Effect of high K, low K, and quinidine on QRS duration and ventricular action potential. Am J Physiol 203:1135–1140.

    Google Scholar 

  35. Dyckner T, Wester PO (1979) Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment. Am Heart J 97:12–18.

    Google Scholar 

  36. Reinhart RA (1988) Magnesium metabolism. A review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med 148:2415–2420.

    Google Scholar 

  37. Watanabe Y, Dreifus LS (1972) Electrophysiological effects of magnesium and its interactions with potassium. Cardiovasc Res 6:79–88.

    Google Scholar 

  38. Polimeni PI, Page E (1973) Magnesium and heart muscle. Circ Res 33:367–374.

    Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 340, FIN-00029, Helsinki, Finland

    Hannu Parikka M.D., Lauri Toivonen M.D., Ph.D. & Markku S. Nieminen M.D., Ph.D. (F.I.C.A.)

  2. Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Helsinki, Finland

    Kalervo Verkkala M.D. & Antero Järvinen M.D.

Authors
  1. Hannu Parikka M.D.
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  2. Lauri Toivonen M.D., Ph.D.
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  3. Kalervo Verkkala M.D.
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  4. Antero Järvinen M.D.
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  5. Markku S. Nieminen M.D., Ph.D.
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Additional information

This study was supported by a grant from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland

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Parikka, H., Toivonen, L., Verkkala, K. et al. Ventricular arrhythmia suppression by magnesium treatment after coronary artery bypass surgery. International Journal of Angiology 8, 165–170 (1999). https://doi.org/10.1007/BF01616447

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