{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:22:45Z","timestamp":1780604565951,"version":"3.54.1"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>New-onset atrial fibrillation (AF) after cardiac surgery is associated with unfavorable outcomes. Electrolyte imbalances have been described as potential risk factors. The effects of ionized magnesium (iMg), a component of total magnesium (tMg) concentration in the blood, and the influence of iMg-dynamics on the incidence of postoperative atrial fibrillation (POAF) are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ionized Magnesium Levels and Atrial Fibrillation in Patients undergoing Cardiac surgery (iMagic) was a single-center prospective cohort study. A total of 200 patients were enrolled over six months. Plasma-iMg and -tMg levels were measured at different time points in patients without pre-existing AF undergoing on-pump cardiac surgery. The primary outcome was the incidence of POAF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 200 participants, 55 (27.5%) developed new-onset POAF. Ionized magnesium levels at five pre-specified time points did not vary significantly between patients who later developed POAF and those who did not. Exploratory analyses showed a trend toward higher postoperative iMg, but not tMg (0.78 mmol\/L, standard deviation [SD] 0.1 vs. 0.74 mmol\/L, SD 0.11, P\u2009=\u20090.096) in patients who developed POAF. This exploratory finding was more pronounced in patients who underwent isolated coronary artery bypass graft (CABG) surgery, and at certain time points, including anesthesia induction (mean iMg 0.71 mmol\/L, SD 0.11 vs. 0.65 mmol\/L, SD 0.07, P\u2009=\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Plasma-iMg levels did not vary between cardiac surgery patients who developed POAF and those who did not. Exploratory subgroup analyses indicated that iMg-levels may be associated with POAF in patients undergoing isolated CABG surgery. Perioperative measurement of iMg in patients at risk of POAF undergoing isolated CABG surgery may be beneficial, but more data are needed to support our preliminary findings. The risk factors for dysmagnesemia and subsequent patient-centered outcomes, such as new-onset POAF, have yet to be described for cardiac surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345860","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T17:48:25Z","timestamp":1775152105000},"page":"e0345860","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ionized magnesium levels and atrial fibrillation in patients undergoing cardiac surgery \u2013 The iMagic Prospective Cohort Study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-5199","authenticated-orcid":true,"given":"Mahan","family":"Sadjadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"von Groote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Krone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7525-2172","authenticated-orcid":true,"given":"Ludwig Maximilian","family":"Sch\u00f6ne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Strau\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3859-5437","authenticated-orcid":true,"given":"Moritz J.","family":"Mertes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Dinkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Schellnack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fraune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Wempe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zarbock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Booke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Gottschalk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"8","key":"pone.0345860.ref001","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.jacc.2007.10.043","article-title":"Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery","volume":"51","author":"N Echahidi","year":"2008","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0345860.ref002","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1161\/01.CIR.94.3.390","article-title":"Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources","volume":"94","author":"SF Aranki","year":"1996","journal-title":"Circulation"},{"issue":"5","key":"pone.0345860.ref003","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jacc.2003.11.023","article-title":"Postoperative atrial fibrillation and mortality after coronary artery bypass surgery","volume":"43","author":"RP Villareal","year":"2004","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0345860.ref004","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ijcard.2007.07.123","article-title":"Atrial fibrillation after cardiac surgery: risk factors and their temporal relationship in prophylactic drug strategy decision","volume":"129","author":"G Mariscalco","year":"2008","journal-title":"Int J Cardiol"},{"issue":"23","key":"pone.0345860.ref005","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1161\/CIR.0000000000000040","article-title":"AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society","volume":"130","author":"CT January","year":"2014","journal-title":"Circulation"},{"issue":"10","key":"pone.0345860.ref006","first-page":"1170","article-title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation","volume":"32","author":"L Macle","year":"2016","journal-title":"Can J Cardiol"},{"issue":"3","key":"pone.0345860.ref007","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/CRD.0000000000000499","article-title":"Prevention of Atrial Fibrillation After Cardiac Surgery: A Review of Literature and Comparison of Different Treatment Modalities","volume":"32","author":"J Halonen","year":"2024","journal-title":"Cardiol Rev"},{"issue":"6","key":"pone.0345860.ref008","first-page":"781","article-title":"Post-operative Atrial Fibrillation \u2013 Pathophysiology, Treatment and Prevention","volume":"5","author":"E Bidar","year":"2013","journal-title":"J Atr Fibrillation"},{"key":"pone.0345860.ref009","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jcrc.2017.05.038","article-title":"Magnesium status and magnesium therapy in cardiac surgery: a systematic review and meta-analysis focusing on arrhythmia prevention","volume":"42","author":"JL Fairley","year":"2017","journal-title":"J Crit Care"},{"issue":"17","key":"pone.0345860.ref010","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1001\/jama.1992.03490170067027","article-title":"Magnesium administration and dysrhythmias after cardiac surgery: a placebo-controlled, double-blind, randomized trial","volume":"268","author":"MR England","year":"1992","journal-title":"JAMA"},{"issue":"2","key":"pone.0345860.ref011","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1067\/mtc.2003.108","article-title":"Intravenous magnesium sulfate prophylaxis for atrial fibrillation after coronary artery bypass surgery","volume":"125","author":"M Kaplan","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"pone.0345860.ref012","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1136\/hrt.2004.033811","article-title":"Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis","volume":"91","author":"S Miller","year":"2005","journal-title":"Heart"},{"issue":"1","key":"pone.0345860.ref013","doi-asserted-by":"crossref","first-page":"236","DOI":"10.3390\/nu15010236","article-title":"Ionized Magnesium: Interpretation and Interest in Atrial Fibrillation","volume":"15","author":"J-B Bouillon-Minois","year":"2023","journal-title":"Nutrients"},{"issue":"4","key":"pone.0345860.ref014","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/ejcts\/ezx039","article-title":"Postoperative atrial fibrillation following cardiac surgery: a persistent complication","volume":"52","author":"JW Greenberg","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"issue":"4","key":"pone.0345860.ref015","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.athoracsur.2016.06.066","article-title":"Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis","volume":"102","author":"TS Lancaster","year":"2016","journal-title":"Ann Thorac Surg"},{"issue":"7","key":"pone.0345860.ref016","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/s41569-019-0166-5","article-title":"Postoperative atrial fibrillation: mechanisms, manifestations and management","volume":"16","author":"D Dobrev","year":"2019","journal-title":"Nat Rev Cardiol"},{"issue":"4","key":"pone.0345860.ref017","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1378\/chest.73.4.450","article-title":"Supraventricular tachyarrhythmias in hospitalized adults after surgery. Clinical correlates in patients over 40 years of age after major noncardiac surgery","volume":"73","author":"L Goldman","year":"1978","journal-title":"Chest"},{"issue":"8","key":"pone.0345860.ref018","article-title":"Ionized Hypomagnesemia Is Associated With Increased Incidence of Postoperative Atrial Fibrillation After Esophageal Resection: A Retrospective Study","volume":"13","author":"K Hizuka","year":"2021","journal-title":"Cureus"},{"issue":"5","key":"pone.0345860.ref019","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jjcc.2021.06.001","article-title":"Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis","volume":"78","author":"T Ramesh","year":"2021","journal-title":"J Cardiol"},{"issue":"10","key":"pone.0345860.ref020","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.37234","article-title":"Association of intravenous potassium and magnesium administration with spontaneous conversion of atrial fibrillation and atrial flutter in the emergency department","volume":"5","author":"F Cacioppo","year":"2022","journal-title":"JAMA Netw Open"},{"key":"pone.0345860.ref021","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.jcrc.2017.07.026","article-title":"Total and ionized magnesium testing in the surgical intensive care unit - Opportunities for improved laboratory and pharmacy utilization","volume":"42","author":"DD Yeh","year":"2017","journal-title":"J Crit Care"},{"key":"pone.0345860.ref022","first-page":"68","article-title":"Ionized or total magnesium levels, what should we measure in critical ill patients?","volume":"23","author":"G Scarpati","year":"2020","journal-title":"Transl Med UniSa"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345860","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T17:48:30Z","timestamp":1775152110000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345860"}},"subtitle":[],"editor":[{"given":"Vincenzo","family":"Lionetti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345860","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}