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- Title
Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department.
- Authors
Cacioppo, Filippo; Reisenbauer, Denise; Herkner, Harald; Oppenauer, Julia; Schuetz, Nikola; Niederdoeckl, Jan; Schnaubelt, Sebastian; Gupta, Sophie; Lutnik, Martin; Simon, Alexander; Spiel, Alexander O.; Buchtele, Nina; Domanovits, Hans; Laggner, Anton N.; Schwameis, Michael
- Abstract
Key Points: Question: Is the administration of potassium and magnesium associated with the probability of spontaneous conversion of nonpermanent atrial fibrillation and atrial flutter in the emergency department? Findings: In this cohort study that included 2546 episodes of atrial fibrillation and 573 episodes of atrial flutter, administration of potassium and magnesium was associated with higher rates of spontaneous conversion in atrial fibrillation vs no administration (19.2% vs 10.4%) during patients' stay in the emergency department. However, there was no association with atrial flutter (13.0% vs 12.5%). Meaning: The findings of this study suggest that administration of potassium and magnesium might lessen the need for antiarrhythmic therapy and the potential adverse effects in patients with nonpermanent atrial fibrillation. Importance: Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown. Objective: To assess potassium and magnesium administration and SCV probability in AF and AFL in the emergency department. Design, Setting, and Participants: A registry-based cohort study was conducted in the Department of Emergency Medicine of the Medical University of Vienna, Austria. All consecutive patients with AF or AFL were screened between February 6, 2009, and February 16, 2020. Interventions: Intravenous administration of potassium, 24 mEq, and magnesium, 145.8 mg. Main Outcomes and Measures: The primary outcome was the probability of SCV during the patient's stay in the emergency department. Multivariable cluster-adjusted logistic regression was used to estimate the association between potassium and magnesium administration and the probability of SCV. Results: A total of 2546 episodes of nonpermanent AF (median patient age, 68 [IQR, 58-75] years, 1411 [55.4%] men) and 573 episodes of nonpermanent AFL (median patient age, 68 [IQR, 58-75] years; 332 [57.9%] men) were observed. In AF episodes, intravenous potassium and magnesium administration vs no administration was associated with increased odds of SCV (19.2% vs 10.4%; odds ratio [OR], 1.98; 95% CI, 1.53-2.57). In AFL episodes, in contrast, no association was noted for the probability of SCV with potassium and magnesium vs no administration (13.0% vs 12.5%; OR, 1.05; 95% CI, 0.65-1.69). Conclusions and Relevance: The findings of this registry-based cohort study on intravenous administration of potassium and magnesium suggest an increased probability of SCV in nonpermanent AF, but not AFL, during a patients' stay in the emergency department. This cohort study examines the association between administration of combined intravenous potassium and magnesium and spontaneous conversion to sinus rhythm among patients with atrial fibrillation or atrial flutter in the emergency department.
- Subjects
AUSTRIA; INTRAVENOUS therapy; HOSPITAL emergency services; ACADEMIC medical centers; CONFIDENCE intervals; MULTIVARIATE analysis; ATRIAL fibrillation; ATRIAL flutter; POTASSIUM; RISK assessment; PEARSON correlation (Statistics); MAGNESIUM; ELECTROCARDIOGRAPHY; DESCRIPTIVE statistics; ARRHYTHMIA; DATA analysis software; LOGISTIC regression analysis; STATISTICAL correlation; ODDS ratio; LONGITUDINAL method; PROBABILITY theory; DISEASE risk factors
- Publication
JAMA Network Open, 2022, Vol 5, Issue 10, pe2237234
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.37234