LOMAGHI (low-dose MgSO4)
Trial question
What is the role of low-dose magnesium sulfate in patients with rapid AF of > 120 beats/min?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 297
297 patients (123 female, 174 male).
Inclusion criteria: adult patients admitted to the emergency department for rapid AF of > 120 beats/min.
Key exclusion criteria: arterial hypotension; impaired consciousness; renal failure; wide-complex ventricular response; contraindication to magnesium sulfate.
Interventions
N=148 low-dose magnesium (4.5 g intravenous magnesium sulfate in 100 mL of normal saline plus atrioventricular nodal blocking agents).
N=149 placebo (100 mL of intravenous normal saline plus atrioventricular nodal blocking agents).
Primary outcome
Percentage of patients achieving baseline ventricular rate ≤ 90 beats/min or a reduction of VR by ≥ 20% from baseline at 4 hours
64.2%
43.6%
64.2 %
48.2 %
32.1 %
16.1 %
0.0 %
Low-dose
magnesium
Placebo
Borderline significant
increase ▲
Borderline significant increase in the percentage of patients achieving baseline ventricular rate ≤ 90 beats/min or a reduction of VR by ≥ 20% from baseline at 4 hours (64.2% vs. 43.6%; RR 2.31, 95% CI 1.45 to 3.69).
Secondary outcomes
Borderline significant increase in composite outcome of reduction of baseline ventricular rate to ≤ 90 beats/min, or reduction of VR by ≥ 20% from baseline at 24 hours (97.9% vs. 83.3%; RR 9.74, 95% CI 2.87 to 17.05).
Borderline significant decrease in resolution time (6.1 hours vs. 8.4 hours; AD -2.3 hours, 95% CI -4.6 to 0).
Significant increase in sinus rhythm control rate at 24 hours (22.9% vs. 10.7%; AD 12.2%, 95% CI 3.69 to 20.71).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients admitted to the emergency department for rapid AF of > 120 beats/min, low-dose magnesium was superior to placebo with respect to the percentage of patients achieving baseline ventricular rate ≤ 90 beats/min or a reduction of VR by ≥ 20% from baseline at 4 hours.
Reference
Wahid Bouida, Kaouthar Beltaief, Mohamed Amine Msolli 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 Feb;26(2):183-191.
Open reference URL