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High-Dose Intravenous Magnesium for New-Onset Rapid Atrial Fibrillation in the ICU: An Overlooked Strategy?

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Abstract

New-onset atrial fibrillation (AF) is common in the intensive care unit (ICU) and is associated with increased morbidity and mortality. Although current international guidelines provide limited recommendations on magnesium sulfate (MgSO4) use in AF, emerging evidence suggests that high-dose intravenous magnesium may offer a safe and effective strategy for controlling ventricular rate and promoting rhythm conversion in critically ill patients. This perspective paper explores the electrophysiological rationale behind magnesium use, highlights key clinical studies supporting its efficacy, and calls for renewed attention to this underutilized therapeutic option. Given its favorable safety profile and low cost, high-dose magnesium warrants rigorous evaluation in randomized controlled trials (RCTs) and may represent a therapeutic option in future ICU-specific AF management protocols.

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Data Availability

No datasets were generated or analysed during the current study.

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Not applicable. No custom code or software was used in this study.

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Authors and Affiliations

  1. Nam Can Tho University, An Binh Ward, Can Tho City, Viet Nam

    Thanh Luan Nguyen

  2. Nam Can Tho University Medical Center, Cai Rang Ward, Can Tho City, Viet Nam

    Thanh Luan Nguyen

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  1. Thanh Luan Nguyen
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The author conceived the concept, performed the literature review, wrote the manuscript, and approved the final version.

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Correspondence to Thanh Luan Nguyen.

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Nguyen, T.L. High-Dose Intravenous Magnesium for New-Onset Rapid Atrial Fibrillation in the ICU: An Overlooked Strategy?. SN Compr. Clin. Med. 7, 295 (2025). https://doi.org/10.1007/s42399-025-02067-z

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  • DOI: https://doi.org/10.1007/s42399-025-02067-z

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