Magnesium Sulfate for Atrial Fibrillation Management in Chilean High-Resolution Primary Care Emergency Services: An Evidence-Based Protocol


Authors : Dr. Camilo Vidal Araya; Dr. María José Yarí Acosta; Dr. Amanda Oraa

Volume/Issue : Volume 10 - 2025, Issue 7 - July

Google Scholar : https://tinyurl.com/ynz3455x

Scribd : https://tinyurl.com/bdhutrsd

DOI : https://doi.org/10.38124/ijisrt/25jul1683

PlumX Metrics

Semantic Scholar

ResearchGate

Google Scholar

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Note : Google Scholar may take 30 to 40 days to display the article.

Abstract : Introduction: Atrial fibrillation (AF) represents a frequent challenge in Chilean emergency services, particularly in resource-limited settings. This study evaluated the efficacy, safety, and feasibility of magnesium sulfate (MgSO4) as a therapeutic alternative in the acute management of AF in primary emergency care services.  Methods: We conducted a systematic review following PRISMA guidelines, including studies published between 2000-2023 that evaluated the use of intravenous MgSO4 in adults with AF. Outcomes analyzed included ventricular rate control, conversion to sinus rhythm, and adverse effects. Methodological quality was assessed using standardized scales (Jadad, Cochrane, AMSTAR-2, GRADE). Additionally, implementation feasibility was analyzed considering technical, economic, organizational, and regulatory aspects in the context of Chilean SAPU/SAR services.  Results: Eighteen studies were included (11 clinical trials, 4 meta-analyses, 3 systematic reviews) with 1,237 participants. MgSO4 demonstrated significant efficacy for ventricular rate control (OR 1.96-2.49) and moderate efficacy for conversion to sinus rhythm (OR 1.60-1.75). Hoffer et al.'s meta-analysis (2022) with 815 patients confirmed significant heart rate reduction (SMD 0.34; 95% CI 0.21-0.47; p<0.001; I2=4%). The safety profile was favorable, with predominantly mild adverse effects (facial flushing 15-30%, nausea 5-10%) and low incidence of serious effects (hypotension 0-3%, bradycardia 0-2%). Feasibility analysis revealed advantages in availability, cost ($600-800 CLP/ampoule), and ease of implementation in primary emergency services.  Conclusions: Magnesium sulfate constitutes an effective, safe, and cost-efficient alternative for the initial management of atrial fibrillation in Chilean primary emergency services, especially when first-line treatments are contraindicated or unavailable. We propose an implementation protocol adapted to our local reality, with a dose of 2.5 g in slow infusion, recognizing the need for specific studies in the Chilean population.

References :

  1. Onalan O, Crystal E, Daoulah A, Lau C, Crystal A, Lashevsky I. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol. 2007;99(12):1726-1732. doi:10.1016/j.amjcard.2007.01.057
  2. Ramesh T, Lee PYK, Mitta M, Allencherril J. Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis. J Cardiol. 2021;78(5):375-381. doi:10.1016/j.jjcc.2021.05.001
  3. Ho KM, Sheridan DJ, Paterson T. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Heart. 2007;93(11):1433-1440. doi:10.1136/hrt.2006.111492
  4. Bouida W, Beltaief K, Msolli MA, et al. Low-dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double-blind Study (LOMAGHI Study). Acad Emerg Med. 2019;26(2):183-191. doi:10.1111/acem.13522
  5. Chu K, Evans R, Emerson G, Greenslade J, Brown A. Magnesium Sulfate versus Placebo for Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial. Acad Emerg Med. 2009;16(4):295-300. doi:10.1111/j.1553-2712.2009.00368.x
  6. Coleman CI, Sood N, Chawla D, et al. Intravenous magnesium sulfate enhances the ability of dofetilide to successfully cardiovert atrial fibrillation or flutter: results of the Dofetilide and Intravenous Magnesium Evaluation. Europace. 2009;11(7):892-895. doi:10.1093/europace/eup129
  7. Zaouche K, Mhadhbi H, Boubaker R, et al. Le sulfate de magnesium: molecule adjuvante dans la premiere heure de prise en charge de la fibrillation atriale rapide aux urgences. [Magnesium sulfate: an adjunctive therapy in the first hour of management of rapid atrial fibrillation in emergency department]. La Tunisie Medicale. 2018;96(3):165-170.
  8. Gilardi E, Marsiliani D, Nicolò R, et al. Magnesium sulphate in the Emergency Department. Eur Rev Med Pharmacol Sci. 2019;23(9):4052-4063. doi:10.26355/eurrev_201905_17834
  9. Gilardi E, Pomero F, Ravera E, et al. Intravenous Magnesium Sulfate Reduces the Need for Antiarrhythmics during Acute-Onset Atrial Fibrillation in Emergency and Critical Care. J Clin Med. 2022;11(19):5527. doi:10.3390/jcm11195527
  10. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
  11. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2019;140(2):e125-e151. doi:10.1161/CIR.0000000000000665
  12. Ministerio de Salud de Chile (MINSAL). Guía Clínica AUGE: Fibrilación Auricular. Santiago: MINSAL; 2018.
  13. Ministerio de Salud de Chile (MINSAL). Norma Técnica N°16: Servicios de Atención Primaria de Urgencia. Santiago: MINSAL; 2019.
  14. Departamento de Estadísticas e Información de Salud (DEIS). Atenciones de Urgencia APS. Santiago: MINSAL; 2023.
  15. Central Nacional de Abastecimiento (CENABAST). Arsenal Farmacológico y Precios de Referencia. Santiago: MINSAL; 2023.
  16. Fondo Nacional de Salud (FONASA). Arancel de Prestaciones de Salud. Santiago: FONASA; 2023.
  17. Krijthe BP, Heeringa J, Hofman A, Franco OH, Stricker BH. Serum magnesium levels and the risk of atrial fibrillation: the Rotterdam Study. Nutr Metab Cardiovasc Dis. 2013;23(11):1050-1056. doi:10.1016/j.numecd.2012.10.009
  18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
  19. Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial. Lancet. 2020;395(10221):339-349. doi:10.1016/S0140-6736(19)32994-0
  20. Volgman AS, Carberry PA, Stambler B, et al. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation. J Am Coll Cardiol. 1998;31(6):1414-1419. doi:10.1016/s0735-1097(98)00078-3

Introduction: Atrial fibrillation (AF) represents a frequent challenge in Chilean emergency services, particularly in resource-limited settings. This study evaluated the efficacy, safety, and feasibility of magnesium sulfate (MgSO4) as a therapeutic alternative in the acute management of AF in primary emergency care services.  Methods: We conducted a systematic review following PRISMA guidelines, including studies published between 2000-2023 that evaluated the use of intravenous MgSO4 in adults with AF. Outcomes analyzed included ventricular rate control, conversion to sinus rhythm, and adverse effects. Methodological quality was assessed using standardized scales (Jadad, Cochrane, AMSTAR-2, GRADE). Additionally, implementation feasibility was analyzed considering technical, economic, organizational, and regulatory aspects in the context of Chilean SAPU/SAR services.  Results: Eighteen studies were included (11 clinical trials, 4 meta-analyses, 3 systematic reviews) with 1,237 participants. MgSO4 demonstrated significant efficacy for ventricular rate control (OR 1.96-2.49) and moderate efficacy for conversion to sinus rhythm (OR 1.60-1.75). Hoffer et al.'s meta-analysis (2022) with 815 patients confirmed significant heart rate reduction (SMD 0.34; 95% CI 0.21-0.47; p<0.001; I2=4%). The safety profile was favorable, with predominantly mild adverse effects (facial flushing 15-30%, nausea 5-10%) and low incidence of serious effects (hypotension 0-3%, bradycardia 0-2%). Feasibility analysis revealed advantages in availability, cost ($600-800 CLP/ampoule), and ease of implementation in primary emergency services.  Conclusions: Magnesium sulfate constitutes an effective, safe, and cost-efficient alternative for the initial management of atrial fibrillation in Chilean primary emergency services, especially when first-line treatments are contraindicated or unavailable. We propose an implementation protocol adapted to our local reality, with a dose of 2.5 g in slow infusion, recognizing the need for specific studies in the Chilean population.

CALL FOR PAPERS


Paper Submission Last Date
31 - December - 2025

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe