New-onset atrial fibrillation (AF) is a frequent complication in the intensive care unit (ICU) and is associated with poorer patient outcomes. Despite international guidelines offering limited recommendations, a growing body of evidence suggests that high-dose intravenous magnesium sulfate (MgSO4​) can be a safe and effective treatment.

It shows promise for controlling heart rate and restoring normal rhythm in critically ill patients.

This paper examines the electrophysiological basis for using magnesium in AF and reviews important clinical studies that support its use.

It argues that high-dose magnesium is an underused therapeutic option that deserves more attention.

Given its safety and low cost, high-dose magnesium should be a focus of future randomized controlled trials and may become a key component of future AF treatment guidelines for ICU patients.

Magnesium plays a crucial role in the electrical activity of the heart. It can help stabilize the heart muscle’s electrical signals, which are often disorganized in AF. By influencing these signals, magnesium can help slow a rapid heart rate and potentially correct the irregular rhythm.

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