Acute vestibular neuritis may provoke atrial fibrillation

Abstract

BackgroundExclusion of stroke is the focus of guidelines in the emergency department assessment of acute vertigo, especially with new‐onset atrial fibrillation (AF). Early diagnosis of vestibular neuritis (VN) is also important but may be deferred awaiting brain magnetic resonance imaging (MRI) for exclusion of stroke. This may delay potentially beneficial corticosteroid therapy.AimsTo highlight that VN can provoke acute AF.MethodsIn the course of a prospective study of acute vertigo in patients assessable within 24 h of admission, we encountered three patients with acute onset transient AF associated with VN. We performed a detailed neurological examination and quantitated the vestibulo‐ocular reflex (VOR) gain with video‐oculography. Brain MRI was performed in all patients.ResultsThere were two men and one woman, aged 58–66 (mean 61) years. All patients had typical non‐direction‐changing rotatory nystagmus and positive head impulse tests. The horizontal VOR gains ranged 0.38–0.62 (mean 0.47). Diffusion‐weighted MRI within 36 h was normal in all. AF reverted in all three within 24 h.ConclusionsAcute AF can be precipitated by vertigo such as in VN. In VN, the concurrence of acute AF may distract from the correct neurological diagnosis, delaying potentially beneficial corticosteroid therapy, especially if exclusion of stroke is dependent on MRI, which may be delayed.

Comment on: ‘Acute vestibular neuritis may provoke atrial fibrillation’

“…I thank the authors for bringing this association to the reader's attention. 1 I have encountered two similar patients with transient atrial fibrillation in association with vestibular dysfunction: one with vestibular neuritis and another with unspecified vestibular disturbance, but probably Meniere disease. Both patients had negative magnetic resonance imaging, and one received long-term anticoagulation.…”

Author reply to Prentice: “Acute vestibular neuritis may provoke atrial fibrillation”

“…We thank Prentice for his interest in our paper, 1 and we are pleased to learn that he too has seen this phenomenon of vestibular neuritis (VN)-induced atrial fibrillation (AF). 2 He proposes that asymmetrical leftdominant vagal innervation of the atria may account for our encountering AF precipitated by VN on the left in all four of our cases. Subsequently, we have encountered a further case of AF precipitated by right VN, but it may still be that left-sided VN would predominate in a larger series.…”