an IV preparation of potassium and magnesium for emergency remedy?

an IV preparation of potassium and magnesium for emergency remedy?

Vienna, Austria The probability of spontaneous cardioversion to sinus rhythm (SR) is elevated by intravenous administration of magnesium and potassium in sufferers with paroxysmal atrial fibrillation presenting to the emergency division (SAU): that is the results of a brand new registry examine.

In comparison with no remedy, administration of a preparation containing potassium and magnesium elevated the conversion to sinus rhythm by 10%.

These outcomes recommend that intravenous potassium and magnesium might cut back the necessity for antiarrhythmic remedy and its doable unwanted side effects in sufferers with non-permanent atrial fibrillation, summarize the authors.

Earlier than including: “the outcomes of our examine have a direct implication in medical follow for the administration of sufferers with AF or atrial flutter (AFL) within the UAS. It’s merely preliminary and hypothetical knowledge which will set up a rationale for future potential trials”.

The examine was printed on-line October 19 within the Open JAMA Community [1].

Cohort examine in sufferers with AF or FLA

“Atrial fibrillation is a rising scourge for healthcare techniques worldwide within the face of an growing old inhabitants,” write the Dr Filippo Cacioppoand colleagues from the Medical College of Vienna, Austria.

“Drug and electrical conversion are normal remedies in emergency departments, particularly in symptomatic sufferers. Every process has its personal dangers and none is superior to the opposite when it comes to value given the frequent recurrences of AF. Furthermore, AF typically resolves by itself, spontaneously,” write Cacioppo et al.

They add that there are related arguments indicating that hypokalemia and hypomagnesemia contribute to the prevalence of AF, so the administration of potassium and magnesium may very well be an inexpensive technique to enhance the speed of return to SR. .

To check their speculation, Cacioppo et al. performed a cohort examine based mostly on a registry itemizing all sufferers with AF or AFL who introduced to the SAU of their heart between February 6, 2009 and February 16, 2020.

Potassium/magnesium IV in additional than half of sufferers

Throughout this era, they recorded a complete of 2546 episodes of paroxysmal AF. The typical age of the sufferers was 68 years (Interquartile Vary [IQR] 58-75 years outdated) most of whom had been males (1411 or 55.4%).

Moreover, there have been 573 episodes of paroxysmal FLA. The typical age of the sufferers being 68 years (IQR 58-75 years) together with 332 male topics (57.9%)

The IV potassium/magnesium mixture was utilized in simply over half of the sufferers (1763, 56.5%).

This potassium and magnesium content material got here from a pre-made 250mL infusion bag, which contained 24 mmol of potassium and 145.8 mg [5,6 mmol] of magnesium, diluted in a 500 mL answer which contained 2.5 mmol of potassium and 18.2 mg [0,7 mmol] of magnesium, the answer being injected for 90 minutes, specify the authors.

If the affected person reported ache on the injection web site, the infusion charge was slowed till the ache subsided.

Conversion to sinus rhythm was thought-about spontaneous if it occurred earlier than a rhythm-restoring product was administered or if reversion to SR occurred after an unsuccessful try at electrical conversion or after using slowing merchandise. cadence: beta blockers, non-dihydropyridine calcium channel blockers, and even digitalis, point out the authors.

IV remedy will increase the probability of return to SR

The typical size of keep within the SAU was 6.4 hours (IQR 3.Sep 11.6) in sufferers with AF and 6.1 hours (IQR 3.Sep 11.8 hours) in these with FLA.

Throughout their keep within the SAU, the return to RS came about in 15.4% (n=393) of sufferers in AF and 12.7% (n=73) in these in FLA.

The potassium/magnesium answer will increase the opportunity of return to RS in comparison with the affected person in AF, however this isn’t noticed in these in FLA.

In case of AF, the administration of potassium magnesium answer is related to the likelihood of return to SR of 19.2%, in comparison with 10.4% when the answer shouldn’t be used (Odds Ratio, [OR]1.98: [IC 1,53-2,57]).

Quite the opposite for the FLA there was no relationship between the return to SR and the administration of potassium magnesium in comparison with the absence of injection (13.0% vs 12.5%, OR: 1, 05; [IC 95% : 0,65-1,69]).

no labels tips

“At present, it’s not recognized whether or not the administration of potassium and magnesium would show cheap for the acute remedy of AF and FLA and, though this intervention is practiced in some EDs, it’s not a part of the suggestions” write Dr. Cacioppo and Coll.

“Our outcomes recommend that intravenous injection of potassium and magnesium would improve the probabilities of conversion to RS in sufferers with hypokalaemia or when the plasma potassium focus is between 3.50 and three.99 mmol/L. In sufferers who’ve FLA, the administration of potassium and magnesium wouldn’t enable it” they point out.

Cacioppo et al. add that of their examine, the intravenous administration of potassium and magnesium solely allowed a return to RS in sufferers who had began their signs lower than 48 hours earlier, suggesting a relationship between efficacy and time. Nonetheless, they mood “as a result of we solely have a restricted variety of decreased sufferers in SR whose signs had appeared at 48 hours or past, this requires additional investigation”

Like a band-aid

“I am a bit skeptical about this examine,” feedback the Physician Georgios Syrosdirector of the arrhythmia division Mount Sinai Queens and Mount Sinai Brooklyn, New Yorkto pay Cardiology.

“Atrial fibrillation is a continual situation. The pure historical past of this illness is made up of paroxysms firstly and from a sure time the episodes change into extra frequent after which more and more lengthy in period. For some, sooner or later, it turns into everlasting. remarks Syros.

“Suppose I reduce my finger after I’m slicing bread. I put a bandage on the reduce. That does not imply I cured her, it is simply non permanent. There’s an analogy with atrial fibrillation on this paper,” he says. “The affected person having episodes, goes to the emergency division, you administer remedy and also you stabilize the state of affairs briefly. Thus, the affected person shouldn’t be hospitalized. It is easy, cheap, you bought your coronary heart rhythm again to regular – however not completely – with few unwanted side effects besides perhaps ache on the injection web site however that does not imply that you’ve mastered AM over the long run. Nonetheless, for individuals who have had a primary episode or don’t wish to keep within the hospital, as a result of it’s the weekend, then sure you should utilize this “band-aid”” he ends.

The IV potassium and magnesium answer proposed on this examine is just like a drug generally utilized in Europe, the product known as Vernakalant, says Dr. Syros.

“Vernakalant shouldn’t be FDA cleared in america. It isn’t devoted to the long-term remedy of atrial fibrillation, so we have to educate the general public concerning the limits of what we’re doing,” he says. “Vernakalant is just like the potassium and magnesium used on this examine, however it’s costlier. It permits sufferers to get better a sinus rhythm briefly, it’s not the magic method sadly”

Dr. Syros insists on the truth that the outcomes of this examine apply solely to instances of atrial fibrillation evolving for lower than 48 hours. “It is an important distinction,” he stated.

For instance, a affected person who drank greater than moderately and the following day suffers from AF, what we name the heart-of-the-weekend (vacation coronary heart) can be a great candidate for the remedy described on this examine. He’s younger, has no coronary heart illness, no diabetes, no hypertension, no historical past of stroke, if he can certify to us that the dysfunction began lower than 48 hours in the past, c It is clear we may help him with remedy with potassium and magnesium,” concludes Dr. Syros.

The outcomes of this examine apply solely to instances of atrial fibrillation evolving for lower than 48 hours.

The potassium magnesium (aspartate) preparation within the examine (Particular Elozell) shouldn’t be out there in France. It is suggested for the IV remedy of convulsions (together with eclampsia). Class III antiarrhythmic Vernakalant [2] is listed within the ESC suggestions [3]. Similar to Ibutilide (class III antiarrhythmic) which is permitted by the FDA however not in France. JPU.

Funding and hyperlinks of curiosity
Drs. Cacioppo et al. and Syros specify that they haven’t any monetary curiosity on this examine. The correspondent for this examine Dr. Jan Niederdoeckl obtained funding for this.

The article was initially printed as IV Potassium and Magnesium an Acute Therapy for AF? Translated by Dr. Jean-Pierre Usdin.

#preparation #potassium #magnesium #emergency #remedy

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