Ann Clin Neurophysiol.  2021 Apr;23(1):1-6. 10.14253/acn.2021.23.1.1.

Updates in postural tachycardia syndrome

• Moon J

• KMID: 2515602
• DOI: http://doi.org/10.14253/acn.2021.23.1.1

Abstract

Postural tachycardia syndrome (POTS) is the most common form of orthostatic intolerance in young people. However, it is still considered an underrecognized disorder and so deserves more attention from clinicians. This review covers the diagnostic challenges, correlations between the symptoms, evidence of autoimmune involvement in the pathogenesis, and treatment strategies in POTS.

Keyword

Postural orthostatic tachycardia syndrome; Diagnosis; Symptoms; Autoimmunity; Treatment

Reference

1. Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural orthostatic tachycardia syndrome: JACC focus seminar. J Am Coll Cardiol. 2019; 73:1207–1228.

2. Mathias CJ, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R. Postural tachycardia syndrome—current experience and concepts. Nat Rev Neurol. 2011; 8:22–34.

3. Moon J, Kim DY, Byun JI, Sunwoo JS, Lim JA, Kim TJ, et al. Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome. Health Qual Life Outcomes. 2016; 14:144.

4. Pandian JD, Dalton K, Henderson RD, McCombe PA. Postural orthostatic tachycardia syndrome: an underrecognized disorder. Intern Med J. 2007; 37:529–535.

5. Lkhagvasuren B, Oka T, Kawai K, Takii M, Kanemitsu Y, Tokunaga S, et al. Prevalence of postural orthostatic tachycardia syndrome in patients with psychiatric disorders. Psychother Psychosom. 2011; 80:308–309.

6. Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc. 2012; 87:1214–1225.

7. Bagai K, Song Y, Ling JF, Malow B, Black BK, Biaggioni I, et al. Sleep disturbances and diminished quality of life in postural tachycardia syndrome. J Clin Sleep Med. 2011; 7:204–210.

8. Reynolds GK, Lewis DP, Richardson AM, Lidbury BA. Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australian cohort. J Intern Med. 2014; 275:409–417.

9. Lewis I, Pairman J, Spickett G, Newton JL. Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome. J Intern Med. 2013; 273:501–510.

10. Karas B, Grubb BP, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing Clin Electrophysiol. 2000; 23:344–351.

11. Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Haythornthwaite JA, Low PA. Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc. 2002; 77:531–537.

12. Schmidt LL, Karabin BL, Malone AC. Postural orthostatic tachycardia syndrome (POTS): assess, diagnose, and evaluate for POTS treatment (ADEPT). Integr Med Int. 2017; 4:142–153.

13. Sheldon RS, Grubb BP 2nd, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015; 12:e41–e63.

14. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011; 21:69–72.

15. Garland EM, Celedonio JE, Raj SR. Postural tachycardia syndrome: beyond orthostatic intolerance. Curr Neurol Neurosci Rep. 2015; Jul. 22. [Epub]. DOI:10.1007/s11910-015-0583-8.

16. Brewster JA, Garland EM, Biaggioni I, Black BK, Ling JF, Shibao CA, et al. Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome. Clin Sci (Lond). 2012; 122:25–31.

17. Moon J, Lee HS, Byun JI, Sunwoo JS, Shin JW, Lim JA, et al. The complexity of diagnosing postural orthostatic tachycardia syndrome: influence of the diurnal variability. J Am Soc Hypertens. 2016; 10:263–270.

18. Li H, Yu X, Liles C, Khan M, Vanderlinde-Wood M, Galloway A, et al. Autoimmune basis for postural tachycardia syndrome. J Am Heart Assoc. 2014; 3:e000755.

19. Blitshteyn S, Brook J. Postural tachycardia syndrome (POTS) with anti-NMDA receptor antibodies after human papillomavirus vaccination. Immunol Res. 2017; 65:282–284.

20. Brinth L, Theibel AC, Pors K, Mehlsen J. Suspected side effects to the quadrivalent human papilloma vaccine. Dan Med J. 2015; 62:A5064.

21. Brinth LS, Pors K, Theibel AC, Mehlsen J. Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus. Vaccine. 2015; 33:2602–2605.

22. Blitshteyn S. Postural tachycardia syndrome after vaccination with Gardasil. Eur J Neurol. 2010; 17:e52.

23. Blitshteyn S. Postural tachycardia syndrome following human papillomavirus vaccination. Eur J Neurol. 2014; 21:135–139.

24. Kinoshita T, Abe RT, Hineno A, Tsunekawa K, Nakane S, Ikeda S. Peripheral sympathetic nerve dysfunction in adolescent Japanese girls following immunization with the human papillomavirus vaccine. Intern Med. 2014; 53:2185–2200.

25. Dahan S, Tomljenovic L, Shoenfeld Y. Postural orthostatic tachycardia syndrome (POTS)–a novel member of the autoimmune family. Lupus. 2016; 25:339–342.

26. Ruzieh M, Batizy L, Dasa O, Oostra C, Grubb B. The role of autoantibodies in the syndromes of orthostatic intolerance: a systematic review. Scand Cardiovasc J. 2017; 51:243–247.

27. Fedorowski A, Li H, Yu X, Koelsch KA, Harris VM, Liles C, et al. Antiadrenergic autoimmunity in postural tachycardia syndrome. Europace. 2017; 19:1211–1219.

28. Vernino S, Stiles LE. Autoimmunity in postural orthostatic tachycardia syndrome: current understanding. Auton Neurosci. 2018; 215:78–82.

29. Blitshteyn S. Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS). Lupus. 2015; 24:1364–1369.

30. Shin YW, Moon J, Kim TJ, Kim DY, Chang H, Jun JS, et al. Human leukocyte antigen associations in postural tachycardia syndrome. Ann Clin Transl Neurol. 2019; 6:962–967.

31. Li H, Zhang G, Zhou L, Nuss Z, Beel M, Hines B, et al. Adrenergic autoantibody-induced postural tachycardia syndrome in rabbits. J Am Heart Assoc. 2019; 8:e013006.

32. Miller AJ, Doherty TA. Hop to it: The first animal model of autoimmune postural orthostatic tachycardia syndrome. J Am Heart Assoc. 2019; 8:e014084.

33. Zhang Q, Xu B, Du J. Update of individualized treatment strategies for postural orthostatic tachycardia syndrome in children. Front Neurol. 2020; 11:525.

34. Joyner MJ. Exercise training in postural orthostatic tachycardia syndrome: blocking the urge to block β-receptors? Hypertension. 2011; 58:136–137.

35. Wieling W, Colman N, Krediet CP, Freeman R. Nonpharmacological treatment of reflex syncope. Clin Auton Res. 2004; 14 Suppl 1:i62–i70.

36. Grubb BP. Postural tachycardia syndrome. Circulation. 2008; 117:2814–2817.

37. Sousa A, Lebreiro A, Freitas J, Maciel MJ. Long-term follow-up of patients with postural tachycardia syndrome. Clin Auton Res. 2012; 22:151–153.

38. Raj SR, Black BK, Biaggioni I, Paranjape SY, Ramirez M, Dupont WD, et al. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome less is more. Circulation. 2009; 120:725–734.

39. Freitas J, Santos R, Azevedo E, Costa O, Carvalho M, de Freitas AF. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone. Clin Auton Res. 2000; 10:293–299.

40. Kanjwal K, Karabin B, Sheikh M, Elmer L, Kanjwal Y, Saeed B, et al. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol. 2011; 34:750–755.

41. Hoeldtke RD, Bryner KD, Hoeldtke ME, Hobbs G. Treatment of postural tachycardia syndrome: a comparison of octreotide and midodrine. Clin Auton Res. 2006; 16:390–395.

42. Miller AJ, Raj SR. Pharmacotherapy for postural tachycardia syndrome. Auton Neurosci. 2018; 215:28–36.

43. Moon J, Kim DY, Lee WJ, Lee HS, Lim JA, Kim TJ, et al. Efficacy of propranolol, bisoprolol, and pyridostigmine for postural tachycardia syndrome: a randomized clinical trial. Neurotherapeutics. 2018; 15:785–795.

44. Chen L, Wang L, Sun J, Qin J, Tang C, Jin H, et al. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J. 2011; 75:927–931.