Je vais réviser les études. La dose usuelle est de 2 gm IV puis un drip. La Mg a tendance à s'équilibrer rapidement. Évidemment, ne règle pas la question du rate control en soi: une fois qu'on aurait donné le MG, que fait-on? L'avantage des agents "simples" comme le metoprolol, c'est la capacité de les ajuster/débuter PO rapidement, ce qui fait qu'on saura si le rate control est adéquat ou non, qu'on veuille ou non demeurer en rate ou rythm control. Si on utilise le MG, cela ne nous guide pas sur ce que l'on fera avec les autres Rx. Par contre, il peut exister des situations ou justement, on ne souhaite pas modifier la médication, ou même la démarrer, surtout en stratégie de rythm control: on peut vouloir continuer les mêmes médicaments. L'avantage est qu'il est probablement sécuritaire. Alors MG seul puis rythm control (beau cas pour donner par exemple propafenone ou flecainide PO ou bien faire une CVE. Bref, une stratégie qui pourrait trouver sa place. Alain
_____ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Catherine Bich Sent: 16 septembre 2007 18:48 To: [email protected] Subject: URG-L: RE: URG-L: RE: URG-L: Magnésium et FA Quelle dose ? Disons 1-2 g IV en 20 minutes ? C. _____ De : [email protected] [mailto:[EMAIL PROTECTED] De la part de Alain Vadeboncoeur Envoyé : 16 septembre 2007 17:49 À : [email protected] Objet : URG-L: RE: URG-L: Magnésium et FA Très intéressant. Am J <javascript:AL_get(this,%20'jour',%20'Am%20J%20Cardiol.');> Cardiol. 2007 Jun 15;99(12):1726-32. Epub 2007 Apr 26. <http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=Abstract Plus-def&uid=17560883&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/ pii/S0002-9149%2807%2900506-1> Click here to read Links <javascript:PopUpMenu2_Set(Menu17560883);> Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Onala n%20O%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel. Pubmed_RVAbstractPlus> Onalan O, <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cryst al%20E%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVAbstractPlus> Crystal E, <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Daoul ah%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVAbstractPlus> Daoulah A, <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lau%2 0C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub med_RVAbstractPlus> Lau C, <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cryst al%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVAbstractPlus> Crystal A, <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lashe vsky%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPan el.Pubmed_RVAbstractPlus> Lashevsky I. Arrhythmia Services, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. [EMAIL PROTECTED] The profile of electrophysiologic effects of magnesium on the heart suggests that magnesium might be effective in the treatment of atrial fibrillation (AF) in terms of rhythm and rate control. We aimed to investigate the efficacy of magnesium administration in the acute treatment of rapid AF. Randomized controlled trials comparing intravenous magnesium versus placebo or antiarrhythmic agents for the acute management of rapid AF were included. Nine electronic databases were searched for relevant trials from the earliest possible dates through June 2005, as were abstract books from 8 cardiovascular meetings held in the past 10 years. We analyzed all outcomes using a fixed-effect model because of the low number of trials in each comparison. The results were expressed as relative risks (RRs) or odds ratios (ORs) for dichotomous outcomes and weighted mean differences for continuous outcomes, along with their 95% confidence intervals (CIs). Data were pooled for 4 trials (n=303) and 8 trials (n=476), respectively, for rate control (<100 beats/min) and rhythm control. Magnesium was effective in achieving rate control (OR 1.96, 95% CI 1.24 to 3.08) or rhythm control (OR, 1.60, 95% CI 1.07 to 2.39). An overall response was achieved in 86% and 56% of patients in the magnesium and control groups, respectively (OR 4.61 95% CI 2.67 to 7.96). Time to response (in hours) was significantly shorter in the magnesium group (weighted mean difference, -6.98; 95% CI -9.27 to -4.68). The risk of having a major adverse effect in the magnesium group was similar to that in the placebo group (RR 0.85, 95% CI 0.44 to 1.61). In conclusion, the present meta-analysis of published data suggests that intravenous magnesium administration is an effective and safe strategy for the acute management of rapid AF. J'avais déjà essayé une fois, il y a longtemps. Je m'y mets dès cette semaine. Alain _____ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Martin Chénier Sent: 16 septembre 2007 15:23 To: [email protected] Subject: URG-L: Magnésium et FA Est-ce que certains d'entre vous ont lu l'article suivant : Meta-Analysis of Magnesium Therapy for the Acute Management of Rapid Atrial Fibrillation. Am J Cardiol 2007;99:1726-1732. Utilisez-vous le sulfate de Mg dans la FA/Flutter rapide? -- Martin Chénier [EMAIL PROTECTED]
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