European Journal of Emergency Medicine ( IF 4.4 ) Pub Date : 2022-08-01 , DOI: 10.1097/mej.0000000000000941 Megan Hoffer 1 , Quincy K Tran 2, 3 , Ryan Hodgson 1 , Matthew Atwater 1 , Ali Pourmand 1
Atrial fibrillation with rapid ventricular response (Afib/RVR) is a frequent reason for emergency department (ED) visits and can be treated with a variety of pharmacological agents. Magnesium sulfate has been used to prevent and treat postoperative Afib/RVR. We performed a systematic review and meta-analysis to assess the effectiveness of magnesium for treatment of Afib/RVR in the ED. PubMed and Scopus databases were searched up to June 2021 to identify any relevant randomized trials or observational studies. We used Cochrane’s Risk-of-Bias tools to assess study qualities and random-effects meta-analysis for the difference of heart rate (HR) before and after treatment. Our search identified 395 studies; after reviewing 11 full texts, we included five randomized trials in our analysis. There were 815 patients with Afib/RVR; 487 patients (60%) received magnesium treatment, whereas 328 (40%) patients received control treatment. Magnesium treatment was associated with significant reduction in HR [standardized mean difference (SMD), 0.34; 95% CI, 0.21–0.47; P < 0.001; I2 = 4%), but not associated with higher rates of sinus conversion (OR, 1.46; 95% CI, 0.726–2.94; P = 0.29), nor higher rates of hypotension and bradycardia (OR, 2.2; 95% CI, 0.62–8.09; P = 0.22). Meta-regressions demonstrated that higher maintenance dose (corr. coeff, 0.17; P = 0.01) was positively correlated with HR reductions, respectively. We observed that magnesium infusion can be an effective rate control treatment for patients who presented to the ED with Afib/RVR. Further studies with more standardized forms of control and magnesium dosages are necessary to assess the benefit/risk ratio of magnesium treatment, besides to confirm our observations.
中文翻译:
硫酸镁在急诊科快速房颤治疗中的应用:系统评价和荟萃分析
伴有快速心室反应的心房颤动 (Afib/RVR) 是急诊科 (ED) 就诊的常见原因,可以使用多种药物治疗。硫酸镁已用于预防和治疗术后 Afib/RVR。我们进行了系统回顾和荟萃分析,以评估镁在 ED 中治疗 Afib/RVR 的有效性。搜索了截至 2021 年 6 月的 PubMed 和 Scopus 数据库,以确定任何相关的随机试验或观察性研究。我们使用 Cochrane 的偏倚风险工具来评估治疗前后心率 (HR) 差异的研究质量和随机效应荟萃分析。我们的搜索确定了 395 项研究;在审阅了 11 篇全文后,我们在分析中纳入了 5 项随机试验。房颤/RVR 患者 815 例;487 名患者(60%)接受了镁治疗,而 328 名(40%)患者接受了对照治疗。镁治疗与 HR 显着降低相关 [标准化平均差 (SMD),0.34;95% CI,0.21–0.47;P < 0.001;I 2 = 4%),但与较高的窦性转化率无关(OR,1.46;95% CI,0.726-2.94;P = 0.29),也与较高的低血压和心动过缓发生率(OR,2.2;95% CI, 0.62–8.09;P = 0.22)。Meta 回归表明,较高的维持剂量(校正系数,0.17;P = 0.01)分别与 HR 降低呈正相关。我们观察到,对于因 Afib/RVR 就诊于 ED 的患者,镁输注可以成为一种有效的心率控制治疗。除了证实我们的观察结果外,还需要进一步研究更标准化的控制形式和镁剂量,以评估镁治疗的效益/风险比。