Potassium & magnesium supplementation therapy in treating atrial fibrillation and flutter
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Reviewed Dat Tien Nguyen, B.A, ScM.
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Posted on November 9th, 2022
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Low level of magnesium and potassium leads to an overabundance of calcium; this electrolyte overload can prolong the duration of the action potential phase and trigger afterdepolarization too early. Previous studies had reported that off-scheduled depolarization can lead to the development of atrial fibrillation (AF). Thus, it is possible that supplementation of magnesium and potassium can restore electrolyte balance and prevent AF; however, there is currently no clinical guideline supporting or discouraging this therapy. A recent study had reported on the possibility of using potassium and magnesium to induce spontaneous conversion to sinus rhythm in patients that have atrial fibrillation and atrial flutter (AFL).
The retrospective study was conducted using the database of patients who had been admitted to the Department of Emergency Medicine of the Medical University of Vienna, Austria between February 6, 2009, and February 16, 2020. The study includes a cohort of 2546 patients who have suffered an episode of atrial fibrillation and a cohort of 573 patients with atrial flutter. Because there is no indication for magnesium and potassium supplementation, the therapy is initiated at the discretion of the attending physician usually to treat electrolyte imbalance. The patients were given an intravenous administration of potassium and magnesium at dosage of 24 mEq and 145.8 mg respectively. In patients with atrial fibrillation, intravenous supplementation of potassium and magnesium help increase the odds of returning to sinus rhythm by approximately two times. Stratification analysis was conducted and found that the therapy created the most significant effect in patients with a baseline concentration of potassium less than 3.99 mEq/L, but there is no association in patients with higher levels. The therapy’s effect is constant across different levels of magnesium. In patients with atrial flutter, potassium and magnesium therapy did not result in conversion to sinus rhythm. These results are promising, and more controlled prospective studies are needed to fully elicit the interaction between electrolyte supplementation and abnormal cardiac rhythm.
The retrospective study was conducted using the database of patients who had been admitted to the Department of Emergency Medicine of the Medical University of Vienna, Austria between February 6, 2009, and February 16, 2020. The study includes a cohort of 2546 patients who have suffered an episode of atrial fibrillation and a cohort of 573 patients with atrial flutter. Because there is no indication for magnesium and potassium supplementation, the therapy is initiated at the discretion of the attending physician usually to treat electrolyte imbalance. The patients were given an intravenous administration of potassium and magnesium at dosage of 24 mEq and 145.8 mg respectively. In patients with atrial fibrillation, intravenous supplementation of potassium and magnesium help increase the odds of returning to sinus rhythm by approximately two times. Stratification analysis was conducted and found that the therapy created the most significant effect in patients with a baseline concentration of potassium less than 3.99 mEq/L, but there is no association in patients with higher levels. The therapy’s effect is constant across different levels of magnesium. In patients with atrial flutter, potassium and magnesium therapy did not result in conversion to sinus rhythm. These results are promising, and more controlled prospective studies are needed to fully elicit the interaction between electrolyte supplementation and abnormal cardiac rhythm.