Atrial fibrillation with a rapid ventricular response (Afib/RVR) can be treated with a range of pharmacological medications and is a common cause of emergency department (ED) visits. Postoperative Afib/RVR has been prevented and treated with magnesium sulfate. For a study, researchers sought to evaluate the efficacy of magnesium for the treatment of Afib/RVR in the ED.

They conducted a systematic review and meta-analysis. They examined the PubMed and Scopus databases up to June 2021 for any pertinent randomized trials or observational studies. They evaluated research quality using Cochrane’s Risk-of-Bias tools and conducted a random-effects meta-analysis to compare heart rate (HR) before and after therapy. A total of 395 studies were found in the search, and after they read through 11 full texts, they included five randomized trials in the analysis.

There were 815 patients with Afib/RVR; 487 (60%) got magnesium medication, whereas 328 (40%) received the control treatment. Treatment with magnesium was linked to a significant reduction in HR [standardized mean difference (SMD), 0.34; 95% CI, 0.21-0.47; P< 0.001; I2 = 4%], but not to higher rates of sinus conversion (OR, 1.46; 95% CI, 0.726-2.94; P=0.29), nor to higher rates of hypotension and bradycardia (OR, 2.2; 95% CI, 0.62-8.09; P=0.22). High maintenance dosage was positively connected with HR decreases, according to meta-regressions (corr. coeff, 0.17; P=0.01). For patients who arrived at the ED with Afib/RVR, magnesium infusion has been found to be an effective rate control medication.

In addition to confirming the findings, further research with more standardized doses and forms of control was required to evaluate the magnesium treatment’s benefit-to-risk ratio.