PROGNOSTIC SIGNIFICANCE OF SERUM MAGNESIUM DEFICIENCY IN PATIENTS WITH HEART ARRHYTHMIAS TAKING CLASS III ANTIARRHYTHMIC DRUGS
Journal: Journal of the Grodno State Medical University (Vol.20, No. 4)Publication Date: 2022-09-19
Authors : L. V. Kalatsei; V. A. Snezhitskiy;
Page : 380-386
Keywords : magnesium; hypomagnesaemia; class III antiarrhythmic drugs; drug-induced long QT syndrome; ventricular arrhythmias; polymorphic ventricular tachycardia;
Abstract
Aim: To determine the prevalence of serum magnesium deficiency in patients with ischemic heart disease and/or arterial hypertension and cardiac arrhythmias taking class III antiarrhythmic drugs and to establish the prognostic value of hypomagnesaemia for the development of drug-induced QT prolongation and ventricular arrhythmias. Material and Methods: The study included 117 patients with ischemic heart disease and/or arterial hypertension and cardiac arrhythmias taking class III antiarrhythmic drugs (amiodarone or sotalol). All patients underwent clinical, laboratory and instrumental studies, including the determination of serum magnesium levels. Depending on the magnesium levels, all patients were divided into 3 groups. Group A (n=21) included patients with serum magnesium below the reference values (<0.75 mmol/l), group B (n=77) – patients with normal magnesium levels (0.75 – 1.0 mmol/l), group C (n=19) – those with magnesium levels above the reference values (≥ 1.0 mmol/l). Results: The incidence of hypomagnesaemia among patients with cardiac arrhythmias was 18%. Serum magnesium levels significantly correlated with the intake of loop diuretics (R=-0.3, p=0.001). In patients with serum magnesium deficiency, higher values were observed for the duration of the corrected QT and JT interval (p<0.001), the interval T peak - T end (p<0.01), as well as the cardiac electrophysiological balance index (p<0.001). Magnesium level <0.75 mmol/l was associated with a risk of drug-induced QT interval prolongation greater than 500 ms in patients receiving antiarrhythmic therapy (OR - 5.87 [95% CI 2.45–13.99]), life-threatening ventricular arrhythmias (OR - 3.81 [95% CI 1.90-7.62]) and non-sustained polymorphic ventricular tachycardia (OR - 4.06 [95% CI 1.77-9.29]). Conclusion: In patients with cardiac arrhythmias taking class III antiarrhythmic drugs, hypomagnesaemia is a predictor of the development of drug-induced QT interval prolongation and life-threatening ventricular arrhythmias including non-sustained polymorphic ventricular tachycardia. Routine determination of serum magnesium levels in patients taking antiarrhythmic drugs may be of value in predicting and preventing drug-induced life-threatening ventricular arrhythmias.
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