MAGNAM Trial, Magnesium Versus Amiodarone in Atrial Fibrillation in Critical Care

Launched by SUNNYBROOK HEALTH SCIENCES CENTRE · Mar 17, 2022

Keywords

ClinConnect Summary

The MAGNAM Trial is a research study that aims to find out if treating new cases of fast atrial fibrillation (a heart condition that causes an irregular and often rapid heartbeat) with high doses of magnesium sulfate, along with digoxin, can help patients in critical care recover more quickly and return their heart rhythm to normal. This study is happening in multiple hospitals, and researchers are looking for patients who are admitted to the Intensive Care Unit (ICU) with this condition.

To be eligible for the trial, patients must be 18 years or older, have a newly diagnosed episode of fast atrial fibrillation with a heart rate above 120 beats per minute, and need medical treatment as decided by their doctor. Participants will receive either the magnesium treatment or the standard treatment, and their progress will be closely monitored. It’s important to know that certain conditions, such as recent heart surgery or specific health issues, may prevent someone from joining the trial. Overall, the study hopes to improve treatment options for critically ill patients experiencing this heart rhythm problem.

Gender

ALL

Eligibility criteria

• Inclusion Criteria: Each participant must meet all of the following inclusion criteria to participate in this study:
• • 1. Admitted to a participating hospital ICU
• • 2. A newly documented episode of fast Atrial Fibrillation with heart rate \>120/min confirmed by a 12-lead ECG assessment regardless of baseline rhythm (note- The AF can be acute or chronic diagnosis)
• • 3. Undergoing, or able to commence continuous electrocardiographic monitoring ("telemetry") as part of their routine clinical care
• • 4. Treating physician determines the patient has clinically significant AF that requires medical treatment
• Exclusion Criteria:
• • 1. Age \<18 years
• • 2. Palliative goals of care or expected to die in the next 12 hours
• • 3. Fast Atrial Fibrillation (\>120/min) present for \> 48 hours
• • 4. Treatment with digoxin or a class I or III anti-arrhythmic medication within the preceding 24 hours
• • 5. MgSO4 dose of \> 3g IV in the last 2 hours.
• • 6. History of high grade Atrio-Ventricular conduction block or bradyarrhythmia without pacemaker
• • 7. Non-cardiac indication or contraindication to one of the study treatments (hypertensive disorders of pregnancy, pre-term labour, neuromuscular junction disorders i.e. known Myasthenia gravis; documented prior history of amiodarone toxicity or relative contraindication such as thyroid disease, cirrhosis, pulmonary fibrosis, etc.)
• • 8. Recent cardiac surgery during index hospital admission
• • 9. Known pregnancy
• • 10. Sustained (more than 10 continuous seconds documented on a rhythm strip) ventricular arrhythmia within the past 24 hours
• • 11. Known or suspected pre-excitation syndrome
• • 12. Persistent hyperkalemia \> 6mmol/l despite treatment
• • 13. Previously enrolled in the MAGNAM trial
• • 14. Recent lung transplantation (during this admission)