Original articleA Prospective, 1-Year Follow-up Study of Postural Tachycardia Syndrome
Section snippets
Study Patients
Study patients needed to meet all 3 of the following criteria to be enrolled in the study: (1) males or females 13 to 50 years of age, (2) orthostatic heart rate increment of 30 beats/min within 5 minutes of HUT, and (3) symptoms of orthostatic intolerance, including weakness, light-headedness, blurred vision, nausea, palpitations, and difficulty with concentration and thinking for a period of greater than 3 months. The Mayo Clinic Institutional Review Board approved this study. All patients
Patient Characteristics
Fifty-eight patients met the criteria for POTS, were enrolled in the current study, and completed 1 year of follow-up. Fifty-four patients were followed up at 1 year. The remaining patients completed their forms but did not return for the follow-up visit. One patient was pregnant. Most patients were female (49) and young (27.4±10.9 years of age). Patients were symptomatic with the disorder for a mean of 3.4 years, 14 (24%) of patients had a history of remote orthostatic intolerance or syncope
Discussion
The main findings of our study were that overall symptoms and functional status (Autonomic Symptom Profile averaged over time) improved and 20 (38%) no longer met orthostatic heart rate criteria for POTS. Other key points are as follows. First, our cohort of patients with POTS consisted of predominantly young females with a variable onset of symptoms, with approximately one-third reporting an antecedent viral infection before the onset of symptoms. Second, heart rate increment on HUT for the
Conclusion
To our knowledge, the current study is the first large cohort of patients studied in a prospective manner with respect to clinical outcomes in POTS. Our patient group revealed improvement in their orthostatic symptoms with minimal mean change in heart rate increment on HUT. The autonomic dysfunction in our patients was mild but yielded evidence of sympathetic denervation in the lower limbs and mild adrenergic dysfunction in keeping with our prior assertion that many of these patients are
Acknowledgments
We thank Pamela Bass, Anita Zeller, and Lauri Louwagie for their administrative help.
References (17)
- et al.
Comparison of the postural tachycardia syndrome (POTS) with orthostatic hypotension due to autonomic failure
J Auton Nerv Syst
(1994) - et al.
Postural orthostatic tachycardia syndrome: the Mayo Clinic experience
Mayo Clin Proc
(2007) - et al.
Postural tachycardia syndrome: clinical features and follow-up study
Mayo Clin Proc
(1999) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure
Mayo Clin Proc
(1993)- et al.
The neuropathic postural tachycardia syndrome
N Engl J Med
(2000) - et al.
Postural tachycardia syndrome (POTS)
J Cardiovasc Electrophysiol
(2009) - et al.
Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome
Circulation
(2005) - et al.
Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?
Neurology
(1993)
Cited by (67)
Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies
2023, Autonomic Neuroscience: Basic and ClinicalPostural tachycardia syndrome among adolescents
2022, Archives de PediatrieHypotension and Syncope
2022, Practical Cardiology: Principles and ApproachesNormal versus abnormal: What normative data tells us about the utility of heart rate in postural tachycardia
2019, Autonomic Neuroscience: Basic and ClinicalClinical neurophysiology of postural tachycardia syndrome
2019, Handbook of Clinical Neurology
Grant Support: This work was supported in part by National Institutes of Health (NS 32352 Autonomic Disorders Program Project, NS 44233 Pathogenesis and Diagnosis of Multiple System Atrophy, U54 NS065736 Autonomic Rare Disease Clinical Consortium), Mayo CTSA (UL1 RR24150), and Mayo Funds. The Autonomic Diseases Consortium is a part of the National Institutes of Health Rare Diseases Clinical Research Network (RDCRN). Funding and/or programmatic support for this project has been provided by U54 NS065736 from the National Institute of Neurological Diseases and Stroke and the National Institutes of Health Office of Rare Diseases Research.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.
Potential Competing Interests: Dr Low is a consultant to WR Medical, Stillwater, MN.