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<p>Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, associated with increased mortality and healthcare costs. While beta-blockers are the recommended prophylaxis, their use may be limited by hemodynamic effects. Magnesium has been proposed as an alternative due to its membrane-stabilizing properties mediated through modulation of calcium handling and suppression of early after-depolarizations. However, its clinical efficacy remains uncertain. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261282792). We searched MEDLINE, Cochrane Central, Scopus, and ClinicalTrials.gov from inception to January 2026 for randomized controlled trials comparing perioperative magnesium with placebo in patients undergoing cardiac surgery. Risk of bias was assessed using RoB 2.0. Random-effects meta-analyses were performed using RevMan 5.4. Certainty of evidence was evaluated using the GRADE framework. Twenty-four randomized trials with a total of 3385 patients were included. Magnesium significantly reduced the incidence of POAF compared with placebo (RR 0.58, 95% CI 0.46–0.74; I<sup>2</sup> = 62%; low-certainty evidence). Magnesium also reduced the need for pharmacological cardioversion (RR 0.33, 95% CI 0.19–0.59; I<sup>2</sup> = 60%; low-certainty evidence) and was associated with shorter ICU stay (MD − 0.34&#xa0;days, 95% CI − 0.59 to − 0.10; I<sup>2</sup> = 96%; moderate-certainty evidence) and hospital stay (MD − 0.67&#xa0;days, 95% CI − 1.27 to − 0.06; I<sup>2</sup> = 86%; low-certainty evidence). No significant differences were observed in all-cause mortality, bradycardia, pacemaker dependence, or duration of intubation (low-to-moderate certainty). Perioperative magnesium supplementation was associated with a reduced incidence of POAF and modest reductions in ICU and hospital length of stay without an increased risk of adverse events. However, substantial heterogeneity and evidence of small-study effects warrant cautious interpretation of effect magnitude. Further trials are needed to define optimal dosing strategies and confirm clinical benefit.</p>

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Magnesium for Preventing Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • Aarushi Batra,
  • Abhishek Pandeya,
  • Jyoti Batra,
  • Ashok Kumar

摘要

Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, associated with increased mortality and healthcare costs. While beta-blockers are the recommended prophylaxis, their use may be limited by hemodynamic effects. Magnesium has been proposed as an alternative due to its membrane-stabilizing properties mediated through modulation of calcium handling and suppression of early after-depolarizations. However, its clinical efficacy remains uncertain. This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261282792). We searched MEDLINE, Cochrane Central, Scopus, and ClinicalTrials.gov from inception to January 2026 for randomized controlled trials comparing perioperative magnesium with placebo in patients undergoing cardiac surgery. Risk of bias was assessed using RoB 2.0. Random-effects meta-analyses were performed using RevMan 5.4. Certainty of evidence was evaluated using the GRADE framework. Twenty-four randomized trials with a total of 3385 patients were included. Magnesium significantly reduced the incidence of POAF compared with placebo (RR 0.58, 95% CI 0.46–0.74; I2 = 62%; low-certainty evidence). Magnesium also reduced the need for pharmacological cardioversion (RR 0.33, 95% CI 0.19–0.59; I2 = 60%; low-certainty evidence) and was associated with shorter ICU stay (MD − 0.34 days, 95% CI − 0.59 to − 0.10; I2 = 96%; moderate-certainty evidence) and hospital stay (MD − 0.67 days, 95% CI − 1.27 to − 0.06; I2 = 86%; low-certainty evidence). No significant differences were observed in all-cause mortality, bradycardia, pacemaker dependence, or duration of intubation (low-to-moderate certainty). Perioperative magnesium supplementation was associated with a reduced incidence of POAF and modest reductions in ICU and hospital length of stay without an increased risk of adverse events. However, substantial heterogeneity and evidence of small-study effects warrant cautious interpretation of effect magnitude. Further trials are needed to define optimal dosing strategies and confirm clinical benefit.