LOMAGHI (high-dose MgSO4)
Trial question
What is the role of high-dose magnesium sulfate in patients with rapid AF of > 120 beats/min?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 302
302 patients (121 female, 181 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=153 high-dose magnesium (9 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 to ≤ 90 beats/min or a reduction of VR by ≥ 20% from baseline at 4 hours
59.5%
43.6%
59.5 %
44.6 %
29.8 %
14.9 %
0.0 %
High-dose
magnesium
Placebo
Borderline significant
increase ▲
Borderline significant increase in the percentage of patients achieving baseline ventricular rate to ≤ 90 beats/min or a reduction of VR by ≥ 20% from baseline at 4 hours (59.5% vs. 43.6%; RR 1.89, 95% CI 1.2 to 2.99).
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 (94.1% vs. 83.3%; RR 3.22, 95% CI 1.45 to 7.17).
Safety outcomes
Significant difference in adverse events (13.7% vs. 2.0%).
Conclusion
In adult patients admitted to the emergency department for rapid AF of > 120 beats/min, high-dose magnesium was superior to placebo with respect to the percentage of patients achieving baseline ventricular rate to ≤ 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.
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