Peripheral vertigo, particularly BPPV, was associated with previous atrial fibrillation

Design

Nationwide propensity-matched case-control study

Population

120,774 adults with new peripheral vestibulopathy and 483,096 matched controls in Taiwan

Primary outcome

Prior atrial fibrillation

Effect

1.53% vs 1.28%; aOR 1.21 (95% CI 1.15–1.28)

This Taiwanese national insurance case-control study compared 120,774 adults with a first diagnosis of peripheral vestibulopathy between 2016 and 2021 with 483,096 propensity-matched controls.

Previous atrial fibrillation was slightly more common in those with vestibulopathy (1.53% vs 1.28%), with an adjusted OR of 1.21 (95% CI 1.15–1.28). The association held for benign paroxysmal positional vertigo (aOR 1.19) and for other or unspecified vestibulopathy (1.28), but not for vestibular neuritis or Ménière's disease.

The absolute difference is small and the design cannot establish direction or mechanism. Its main clinical use is as a reminder that dizziness in older adults sits close to cardiovascular disease, and that a pulse check belongs in every dizziness assessment.

• Check pulse rhythm in every adult presenting with dizziness
• Ask about palpitations and look for AF on ECG where the rhythm is irregular
• Do not attribute unexplained or atypical dizziness to a peripheral cause without excluding cardiac and central causes
• Consider anticoagulation assessment when AF is newly found

Why it matters

Dizziness clinics see many older adults, and an unrecognised arrhythmia is an easy thing to miss.

Don't overread it

A claims-based case-control association — it does not show that AF causes vestibular disease or the reverse.

The statistics, in plain English

An odds ratio of 1.21 represents a small relative difference, and with 1.53% against 1.28% the absolute gap is a quarter of a percentage point. In very large datasets small associations become statistically significant easily, and coding-based diagnoses of vertigo are imprecise.

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