Magnesium for Prevention of New-onset Postoperative Atrial Fibrillation Following Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: This meta-analysis article aimed to investigate the efficacy of magnesium in preventing new-onset postoperative atrial fibrillation (POAF). Methods: We searched Medline, Embase, Web of Science and Cochrane Library without any language or publication date restriction up to August 2023. We included randomized controlled trials (RCTs) that enrolled adults undergoing cardiac surgery without a history of atrial fibrillation, exploring the effect of magnesium supplementation in preventing new-onset POAF. We assessed the risk of bias using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. We conducted a random-effects meta-analysis using R and assessed the certainty of the evidence. Results: A total of 24 RCTs with 3,373 participants were included. We found that magnesium may reduce the risk of POAF compared to the control group (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.41, 0.74; low certainty). The subgroup analysis for trials with low/some concerns risk of bias showed that magnesium reduces the risk of new-onset POAF compared to control (RR: 0.70 [95% CI: 0.58, 0.84]; high certainty). Magnesium consumption had no significant effect on all-cause mortality (RR: 1.00 [95% CI: 0.34, 2.90]) or days of hospitalization (mean difference: -0.34 [95% CI: -0.94, 0.26]). Conclusion: The evidence indicates that magnesium administration reduces the incidence of new-onset POAF.