Abstract
Low magnesium may increase the risk of atrial fibrillation. We conducted a double-blind pilot randomized trial to assess adherence to oral magnesium supplementation (400 mg of magnesium oxide daily) and a matching placebo, estimate the effect on circulating magnesium concentrations, and evaluate the feasibility of using an ambulatory heart rhythm monitoring device (ZioPatch) for assessing premature atrial contractions. A total of 59 participants were randomized; 73% were women, and the mean age was 62 years. A total of 98% of the participants completed the follow-up. In the magnesium supplement group, 75% of pills were taken, and in the placebo group, 83% were taken. The change in magnesium concentrations was significantly greater for those given the magnesium supplements than for those given the placebo (0.07; 95% confidence interval: 0.03, 0.12 mEq/L; p = 0.002). The ZioPatch wear time was approximately 13 of the requested 14 days at baseline and follow-up. There was no difference by intervention assignment in the change in log premature atrial contractions burden, glucose, or blood pressure. Gastrointestinal changes were more common among the participants assigned magnesium (50%) than among those assigned the placebo (7%), but only one person discontinued participation. In sum, compliance with the oral magnesium supplementation was very good, and acceptance of the ZioPatch monitoring was excellent. These findings support the feasibility of a larger trial for atrial fibrillation (AF) prevention with oral magnesium supplementation.
Highlights
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by irregular atrial electrical activity
Small studies in healthy individuals and in patients with cardiac disease have found that intravenous magnesium administration prolongs sinoatrial, intra-atrial, and atrioventricular node conduction and the atrial refractory period, which in turn may contribute to prevent the onset of atrial fibrillation (AF) [22,23,24]
The results from this study provide additional evidence about compliance with magnesium supplementation at the dosage of 400 mg of magnesium daily, as well as safety and tolerability
Summary
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by irregular atrial electrical activity. In the United States (US), more than 3 million individuals had AF in 2010, and this figure is expected to more than double by 2050 [1,2,3]. Current AF treatments, including antiarrhythmic drugs and catheter ablation for rhythm restoration and oral anticoagulation for the prevention of thromboembolism, have suboptimal efficacy and carry significant risks [4]. The limitations of the available therapeutic approaches highlight the need for primary prevention interventions [5,6]. As highlighted in a 2009 National Heart, Lung, and Blood Institute (NHLBI) report [5] and stressed in a more recent Heart Rhythm Society-sponsored whitepaper [6], there is an urgent need to identify new and effective strategies for the primary prevention of AF.
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