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The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. The HINTS clinical decision rule (Head-Impulse test, Nystagmus, Test-of-Skew) allows the physician to identify patients with an acute vestibular syndrome of central origin. HINTS is more sensitive than early magnetic resonance imaging. There is no role for computed tomography in the evaluation of patients with isolated acute vestibular syndrome in the Emergency Department. For patients with benign paroxysmal positional vertigo, simple reposition maneuvers are effective for symptom relief

Anticoagulant and antiarrhythmic agents for atrial fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF treatment involves management of precipitating factors, rate- and rhythm control and anticoagulation for prevention of stroke and systemic thromboembolism. The aims of this thesis were to describe clinical practice in prescription of anticoagulation therapy and trends in ischemic stroke incidence among AF patients, to report plasma concentrations of anticoagulant dabigatran at 110 mg bid under concomitant treatment with antiarrhythmic agent dronedarone in real-life patients and to assess ECG-derived indices of AF organization as predictors of cardioversion with vernakalant. A considerable proportion of AF patients do not receive adequate stroke prevention therapy with oral anticoagulation, despite increased guideline adherence. Efforts to reduce under-treatment should particularly be targeted on female patients 84 years. The increased use of oral anticoagulants between 2011 and 2013 in patients with incident AF is associated with decline in the cumulative incidence of ischemic stroke in Skåne County. Dronedarone and dabigatran are often indicated in the same patient population. Trough plasma concentration of dabigatran at 110 mg bid dose with dronedarone was comparable to plasma dabigatran concentration at the dose of 150 mg bid without concomitant dronedarone in RE-LY study with reportedly low rates of major bleeding and thrombosis. Larger trials on efficacy and safety of this treatment strategy might refute the present contraindication. ECG-derived markers of atrial remodelling failed to predict treatment response in acute cardioversion of AF with vernakalant

Concomitant use of dronedarone with dabigatran in patients with atrial fibrillation in clinical practice.

Dronedarone is a strong P-glycoprotein inhibitor with a potential to increase bioavailability of dabigatran. We sought to measure and report plasma concentrations of dabigatran in patients with atrial fibrillation (AF) on concomitant dronedarone treatment

Predictors of Successful Cardioversion with Vernakalant in Patients with Recent-Onset Atrial Fibrillation.

Vernakalant is a novel atrial-selective antiarrhythmic drug able to convert recent-onset atrial fibrillation (AF) with reportedly low proarrhythmic risk. Successful cardioversion predictors are largely unknown. We sought to evaluate clinical and electrocardiographic predictors of cardioversion of recent-onset AF with vernakalant

Antithrombotic therapy in patients with non-valvular atrial fibrillation in Southern Sweden: A population-based cohort study.

Oral anticoagulants in patients with atrial fibrillation (AF) with moderate-to-high stroke risk are strongly recommended by the current guidelines

Ischemic stroke rates decline in patients with atrial fibrillation as anticoagulants uptake improves : A Swedish cohort study

Introduction The impact of the increased anticoagulants uptake on incidence rate of ischemic stroke is largely unknown. We assessed time trends in rates of ischemic stroke in patients with incident atrial fibrillation (AF) diagnosed between 2011 and 2013. Materials and methods Population-based retrospective registry study of all 11,500 adults diagnosed with incident non-valvular atrial fibrillation in 2011–2013 in primary and secondary care and receiving oral anticoagulants (n = 4847), aspirin (n = 2850) or no treatment (n = 3766) in Skåne County, Sweden. The primary outcome was the rate of ischemic stroke within 365 days after AF diagnosis. Results and conclusion Cumulative incidence of ischemic stroke decreased from 2.87% (95% confidence interval (CI) 2.37–3.45%) to 1.93% (95% CI 1.54–2.41%) while the uptake of oral anticoagulants increased from 36.6% to 48.4% between 2011 and 2013 (regression coefficient − 0.08; 95% CI, − 0.09 to − 0.07, p < 0.001). The increased uptake of oral anticoagulants in the community is associated with decreased incidence of ischemic stroke in AF patients