Optimization of hypomagnesemia diagnostics as an integral element in paroxysmal atrial fibrillation management strategy

Abstract

Purpose. To study magnesium status of patients having paroxysmal atrial fibrillation (AF) based on the use of an integrated clinical and laboratory approach. Methods. A prospective cohort study included 58 patients of the cardiology department of New Hospital Medical Association. The main group consisted of 32 patients having frequently recurring paroxysmal AF, the control group consisted of 26 patients without paroxysmal rhythm disturbance. The clinical status, Holter ECG monitoring data, the test results for magnesium deficiency (MD) clinical evidence, laboratory evidence of calcium, magnesium in blood plasma and formed elements, magnesium in whole blood, free fatty acids (FFA) and osmolality in blood plasma were assessed. Results. The score obtained when assessing MD clinical evidence was significantly higher in the main group patients compared with the control group (16.5 (11÷21) vs. 13 (8÷15), p<0.001). A statistically significant magnesium decrease in whole blood was revealed in patients having paroxysmal AF (0.54 (0.46÷0.60) vs. 0.61 (0.59÷0.64), p<0.001) and inside formed elements (0.68 (0.53÷1.07) vs. 1.31 (1.07÷1.44), p<0.001), which reflected changes in their magnesium status to a greater extent than the measured plasma cation concentrations. A close correlation between magnesium content in formed elements (intracellularly) and AF paroxysms frequency (Spearman’s rank correlation -0.51, p<0.001) was established. A violation of calcium to magnesium ratio in blood plasma (2.6 (2.5÷2.9) vs. 3.0 (2.8÷3.1), p=0.004) and intracellularly (4.85 (2.62÷9.3) vs. 1.85 (1.57÷2.07), p<0.001) was revealed in patients having AF. It has been shown that complex forming interactions with free fatty acids may affect intracellular calcium and magnesium content.