Ann Clin Neurophysiol.  2019 Jan;21(1):30-35. 10.14253/acn.2019.21.1.30.

Prognosis of patients with postural tachycardia syndrome: a follow-up study

• Kang SY
• Kim HJ
• Ko KH

• KMID: 2434184
• DOI: http://doi.org/10.14253/acn.2019.21.1.30

Abstract

BACKGROUND
Postural tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance symptoms associated with a heart rate increment of greater than 30 beats/min, usually up to 120 beats/min, on head-up tilt test. Symptoms related to POTS are usually lightheadedness, palpitations and tremor, but syncope can also occur. The pathophysiology of POTS is heterogeneous and its prognosis is uncertain.
METHODS
We prospectively evaluated patients who met the criteria for POTS, at baseline and follow-up, using composite autonomic symptom scores and autonomic tests to assess the autonomic function. We compared the clinical and autonomic test results between baseline and follow-up.
RESULTS
Sixty-eight patients met the inclusion criteria for POTS and forty-five patients were ultimately followed up for at least 1 year after baseline. The patients were predominantly young females (84%), with a mean age of 21 years. Most patients showed improved orthostatic symptoms and more than a quarter of patients had no longer met the criteria for POTS at follow-up.
CONCLUSIONS
Most patients had a benign outcome in that they could resume their daily activities without great limitations. Our results demonstrated a relatively favorable prognosis in most patients with POTS.

Keyword

Autonomic nervous system; Orthostatic intolerance; Postural tachycardia syndrome; Prognosis

MeSH Terms

Autonomic Nervous System
Dizziness
Female
Follow-Up Studies*
Heart Rate
Humans
Orthostatic Intolerance
Postural Orthostatic Tachycardia Syndrome*
Prognosis*
Prospective Studies
Syncope
Tremor

Reference

References

1. Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, et al. Postural tachycardia syndrome (POTS). Neurology. 1995; 45(4 Suppl 5):S19–S25.

2. Carew S, Connor MO, Cooke J, Conway R, Sheehy C, Costelloe A, et al. A review of postural orthostatic tachycardia syndrome. Europace. 2009; 11:18–25.

3. Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc. 2007; 82:308–313.

4. Stewart JM. Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS). J Pediatr. 2004; 145:725–730.

5. Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006; 17:108–112.

6. Sandroni P, Opfer-Gehrking TL, McPhee BR, Low PA. Postural tachycardia syndrome: clinical features and follow-up study. Mayo Clin Proc. 1999; 74:1106–1110.

7. Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012; 87:1196–1201.

8. Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, et al. The neuropathic postural tachycardia syndrome. N Engl J Med. 2000; 343:1008–1014.

9. Furlan R, Jacob G, Snell M, Robertson D, Porta A, Harris P, et al. Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation. 1998; 98:154–159.

10. Raj SR, Biaggioni I, Yamhure PC, Black BK, Paranjape SY, Byrne DW, et al. Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation. 2005; 111:1574–1582.

11. 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.

12. Low PA, Sandroni P, Joyner MJ, Shen WK. Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol. 2009; 20:352–358.

13. 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.

14. Kimpinski K, Figueroa JJ, Singer W, Sletten DM, lodice V, Sandroni P, et al. A prospective, 1-year follow-up study of postural tachycardia syndrome. Mayo Clin Proc. 2012; 87:746–752.