• Dingchao He, Nimisha Aggarwal, David Zurakowski, Richard A Jonas, Charles I Berul, Sridhar Hanumanthaiah, and Jeffrey P Moak.
• Division of Cardiovascular Surgery, Children's National Health System, Washington, DC.
• J. Thorac. Cardiovasc. Surg. 2018 Aug 1; 156 (2): 763-770.e1.

ObjectivesPostoperative arrhythmias are common in children undergoing congenital heart surgery. We evaluated whether intraoperative administration of magnesium was associated with a reduced occurrence of specific postoperative arrhythmias, as has been described previously, or had a broader effect on multiple arrhythmia types, and whether there existed a dose-effect of intraoperative magnesium.MethodsWe used a historical prospective observational cohort study. Propensity score matching using logistic regression was applied to establish similar populations of treatment groups balanced on 5 important covariates.ResultsBased on propensity score-matched groups, magnesium 50 mg/kg administration was associated with a reduced odds of occurrence of postoperative arrhythmias: any arrhythmia (odds ratio [OR] = 0.50, P < .001), junctional ectopic tachycardia (OR = 0.56, P = .004), accelerated junctional rhythm (OR = 0.56, P = .089), atrial tachycardia (OR = 0.48, P = .005), ventricular tachycardia (OR = 0.52, P = .04), and atrioventricular block (OR = 0.47, P = .03). The effect of magnesium on reducing the odds of occurrence of postoperative arrhythmias did not differ between 25 mg/kg versus 50 mg/kg.ConclusionsAs many as one third of our patients undergoing congenital heart surgery had postoperative arrhythmias. Use of intraoperative magnesium was associated with a reduction in the odds of occurrence of all postoperative arrhythmias. Our results do not provide evidence that a greater dose of magnesium is associated with greater arrhythmia risk reduction. Despite the intraoperative use of magnesium, there continued to be a high residual incidence of postoperative arrhythmias, raising the question for studying new or additional agents.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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