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IN 1935, Zwillinger reported that administration of magnesium, Mg 2+, restored sinus rhythm in patients with digitalis-induced tachyarrhythmias. Since that time, Mg2+ has been used for prophylaxis or therapy in a variety of cardiovascular disorders.

Administration of MgSO4 during electrophysiologic evaluation of patients has demonstrated two effects of Mg 2+ relevant to the treatment of supraventricular tachyarrhythmias:
-  prolongation of atrioventricular nodal conduction time (anterograde and retrograde) and refractory period and
-  suppression of conduction in accessory pathways with and without atrioventricular node-like properties

Other antiarrhythmic effects of Mg2+ have been reported, although the underlying mechanisms have not been defined:
-  restoration of sinus rhythm in critically ill medical and surgical patients with supraventricular tachycardias
-  suppression of intractable ventricular tachyarrhythmias
-  control of ventricular rate in new-onset atrial fibrillation (AF) prophylaxis of AF after coronary artery bypass grafting
-  slowing of digoxin-facilitated ventricular rate during AF in Wolff-Parkinson-White syndrome
-  abolition of preexcitation (Delta wave) in patients with Wolff-Parkinson-White syndrome during normal sinus rhythm
-  suppression of multifocal atrial tachycardia
-  suppression of digoxin-induced ectopic tachyarrhythmias
-  prevention of bupivacaine-induced arrhythmias
-  treatment of amitriptyline-induced ventricular fibrillation.

Mark N. Gomez, MD:Magnesium and Cardiovascular Disease .ANESTHESIOLOGY 1998;89:222-240

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