Magnesiummangel und Magnesiumtherapie bei Herzrhythmusstörungen

Zusammenfassung

Ziele der Empfehlungen der Gesellschaft für Magnesium-Forschung e. V. sind: Erkennen und Ausgleich eines Magnesiummangels bei Patienten mit Risikofaktoren für Herzrhythmusstörungen bzw. mit manifesten kardialen Arrhythmien. Prävention von Herzrhythmusstörungen durch Verabreichung von Magnesium. Therapeutische Einsatzmöglichkeiten von Magnesium bei Patienten mit Arrhythmien mit und ohne Magnesiummangel. Der aktuelle Wissensstand erfordert eine Berücksichtigung des Magnesiumstatus und der Magnesiumtherapie im Konzept der Behandlung kardiovaskulärer Erkrankungen. Die alleinige oder adjuvante Magnesiumanwendung in Prävention und Therapie von Herzrhythmusstörungen ist in vielen Fällen wirksam und bei oraler Verabreichung sicher. Bei parenteraler Anwendung ist es wichtig, die richtige Dosierung zu wählen und neben der Überwachung kardiovaskulärer bzw. neuromuskulärer Parameter auf Kontraindikationen zu achten.

Abstract

Aim of the recommendations of the German Society for Magnesium Research: Recognition and compensation of magnesium deficiency in patients with risk factors for cardiac arrhythmias or manifest rhythm disturbances. Prevention of arrhythmias by administration of magnesium. Therapeutic administration of magnesium in patients with arrhythmias with and without magnesium deficiency. The current state of knowledge claims for considering the status of magnesium and the possibility of a therapeutic intervention with magnesium within the concept of the treatment of cardiovascular diseases. The use of magnesium as single agent or as an adjunct to other therapeutic actions in the prevention and therapy of cardiac arrhythmias can be effective and, in case of oral administration, very safe. In case of parenteral administration, it is important to use adequate doses, monitor cardiovascular and neuromuscular parameters and to consider contraindications.

Schlüsselwörter

Herzrhythmusstörungen - Magnesium - Prävention - Therapieempfehlung

Keywords

cardiac arrhythmias - magnesium - prevention - therapeutic recommendation

• Literatur

• 1 Abdulla W. Interdisziplinäre Intensivmedizin. 3.. Aufl. München: Elsevier; 2006: 340
• 2 Antoni DH, Engel M, Gumpel N. Die Therapie von supraventrikulären und ventrikulären Herzrhythmusstörungen mit Magnesium. Mag Bull 1989; 11: 125-129
• 3 Bailie DS, Inoue H, Kaseda S et al. Magnesium suppression of early afterdepolarizations and ventricular tachyarrhythmias induced by cesium in dogs. Circulation 1988; 77: 1395-1402
• 4 CAST. Preliminary Report: Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406-412
• 5 Cook RC, Humphries KH, Gin K et al. Prophylactic intravenous magnesium sulphate in addition to oral ß-Blockade does not prevent atrial arrhythmias after coronary artery or valvular heart surgery. Circulation 2009; 120: 163-S169
• 6 Davey MJ, Teubner D. A randomized controlled trial of magnesium sulfate, in addition to usual care, for rate control in atrial fibrillation. Ann Emerg Med 2005; 45: 347-353
• 7 De Oliveira Jr GS, Knautz JS, Sherwani S et al. Systemic magnesium to reduce postoperative arrhythmias after coronary artery bypass graft surgery: A meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2012; 26: 643-650
• 8 Dichtl A, Vierling W. Inhibition by magnesium of calcium inward current in heart ventricular muscle. Eur J Pharmacol 1991; 204: 243-248
• 9 Douglas WW, Rubin RP. The mechanism of catecholamine release from the adrenal medulla and the role of calcium in stimulus-secretion coupling. J Physiol 1963; 167: 288-310
• 10 Drew BJ, Ackerman MJ, Funk M et al. Prevention of Torsade de Pointes in Hospital Settings: A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation. Circulation 2010; 121: 1047-1060
• 11 Dunning J, Treasure T, Versteegh M et al. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 2006; 30: 852-872
• 12 Fachinformation Sotalex®. Sotalex® 160 mg/-mite 80 mg. München, FRG.: Bristol-Myers Squibb; Stand der Information: Februar 2010
• 13 Feyertag J, Laimer H, Herglotz P et al. Die Wirkung einer oralen Magnesiumsupplementation auf ventrikuläre Arrhythmien und Parameter des Magnesiumstoffwechsels. Mag Bull 1995; 17: 86-90
• 14 Gu WJ, Wu ZJ, Wang PF et al. Intravenous magnesium prevents atrial fibrillation after coronary artery bypass grafting: a meta-analysis of 7 double-blind, placebo-controlled, randomized clinical trials. Trials 2012; 13: 41-48
• 15 Hall SK, Fry CH. Magnesium affects excitation, conduction, and contraction of isolated mammalian cardiac muscle. Am J Physiol 1992; 263: H622-633
• 16 Ho KM, Sheridan DJ, Paterson T. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Heart 2007; 93: 1433-1440
• 17 Holzgartner H, Maier E, Vierling W. Hochdosierte orale Magnesiumtherapie bei Herzrhythmusstörungen. Ergebnisse einer Anwendungsbeobachtung bei 1160 Patienten mit Arrhythmie. Fortschr Med 1990; 108: 539-542
• 18 Iseri LT. Magnesium and dysrhythmias. Mag Bull 1986; 8: 223-229
• 19 Iseri LT. Role of magnesium in cardiac tachyarrhythmias. Am J Cardiol 1990; 65: 47K-50K
• 20 ISIS-4. A randomised factorial trial assessing early captopril, oral mononitrate, and intravenous magnesium sulphate in 58050 patients with suspected acute myocardial infarction. Lancet 1995; 345: 669-685
• 21 Kaseda S, Gilmour Jr RF, Zipes DP. Depressant effect of magnesium on early afterdepolarizations and triggered activity induced by cesium, quinidine, and 4-aminopyridine in canine cardiac Purkinje fibers. Am Heart J 1989; 118: 458-466
• 22 Kisters K, Cziborra M, Funke C et al. Der Magnesiumhaushalt in der Inneren und Intensivmedizin. Nieren- und Hochdruckkrankheiten 2010; 39: 182-194
• 23 Kisters K, Gröber U. Magnesium Update 2010. DAZ 2010; 150: 2804-2813
• 24 Kulick DL, Hong R, Ryzen E et al. Electrophysiologic effects of intravenous magnesium in patients with normal conduction systems and no clinical evidence of significant cardiac disease. Am Heart J 1988; 115: 367-373
• 25 Lewalter T, Lüderitz B. Antiarrhythmika, Magnesium. In: Lüderitz B, Lewalter T, editors. Herzrhythmusstörungen: Diagnostik und Therapie. Vol. 6. Heidelberg: Springer; 2010: 125-127
• 26 Lewis RV, Tregaskis B, McLay J et al. Oral magnesium reduces ventricular ectopy in digitalised patients with chronic atrial fibrillation. Eur J Clin Pharmacol 1990; 38: 107-110
• 27 Li J, Zhang Q, Zhang M et al. Intravenous magnesium for acute myocardial infarction. Cochrane Database Syst Rev 2007; (02) Art. No.: CD002755. DOI: DOI: 10.1002/14651858.CD002755.pub2.
• 28 Liebscher DH, Baerlocher K, Classen HG et al. Magnesiummangel und -therapie bei ADHS. Nieren- und Hochdruckkrankheiten 2011; 40: 123-128
• 29 Magic Trial Investigators. Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomised controlled trial. Lancet 2002; 360: 1189-1196
• 30 Manz M, Jung W, Lüderitz B. Einfluss von Magnesium auf anhaltende ventrikuläre Tachkardien. Herz 1997; 22 (Suppl. 01) 51-55
• 31 Manz M, Mletzko R, Jung W et al. Behandlung von Herzrhythmusstörungen mit Magnesium. Dtsch Med Wochenschr 1990; 115: 386-390
• 32 Mitchell LB. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery. Can J Cardiol 2011; 27: 91-97
• 33 Onalan O, Crystal E, Daoulah A et al. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol 2007; 99: 1726-1732
• 34 Shechter M. Does magnesium have a role in the treatment of patients with coronary artery disease?. Am J Cardiovasc Drugs 2003; 3: 231-239
• 35 Shepherd J, Jones J, Frampton GK et al. Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation. Health Technol Assess 2008; 12: iii-95
• 36 Shimosawa T, Takano K, Ando K et al. Magnesium inhibits norepinephrine release by blocking N-type calcium channels at peripheral sympathetic nerve endings. Hypertension 2004; 44: 897-902
• 37 Spätling L, Classen HG, Külpmann WR et al. Diagnostik des Magnesiummangels. Aktuelle Empfehlungen der Gesellschaft für Magnesium-Forschung e. V. MMW Fortschr Med 2000; 142: 49-50
• 38 Sueta CA, Clarke SW, Dunlap SH et al. Effect of acute magnesium administration on the frequency of ventricular arrhythmia in patients with heart failure. Circulation 1994; 89: 660-666
• 39 Tong GM, Rude RK. Magnesium deficiency in critical illness. J Intensive Care Med 2005; 20: 3-17
• 40 Turlapaty PDMV, Altura BM. Magnesium deficiency produces spasms of coronary arteries: Relationship to etiology of sudden death ischemic heart disease. Science 1980; 208: 198-200
• 41 Tzivoni D, Banai S, Schuger C et al. Treatment of torsade de pointes with magnesium sulfate. Circulation 1988; 77: 392-397
• 42 Vierling W, Ebner F, Reiter M. The opposite effects of magnesium and calcium on the contraction of the guinea-pig ventricular myocardium in dependence on the sodium concentration. Naunyn Schmiedebergs Arch Pharmacol 1978; 303: 111-119
• 43 von Ehrlich B, Barbagallo M, Classen HG et al. Leitlinie Magnesium und Diabetes. Nieren- und Hochdruckkrankheiten 2009; 38: 633-635
• 44 Woods KL, Fletcher S, Roffe C et al. Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992; 339: 1553-1558
• 45 Zehender M, Meinertz T, Faber T et al. Antiarrhythmic effects of increasing the daily intake of magnesium and potassium in patients with frequent ventricular arrhythmias. Magnesium in Cardiac Arrhythmias (MAGICA) Investigators. J Am Coll Cardiol 1997; 29: 1028-1034
• 46 Zipes DP, Camm AJ, Borggrefe M et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48: e247-346