Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
권호 표지
DOI QR코드

DOI QR Code

Updates in postural tachycardia syndrome

  • Moon, Jangsup (Department of Neurology, Seoul National University Hospital)
  • Received : 2021.01.20
  • Accepted : 2021.02.19
  • Published : 2021.04.30
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  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. https://doi.org/10.1038/nrneurol.2011.187
  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. https://doi.org/10.1186/s12955-016-0548-x
  4. Pandian JD, Dalton K, Henderson RD, McCombe PA. Postural orthostatic tachycardia syndrome: an underrecognized disorder. Intern Med J 2007;37:529-535. https://doi.org/10.1111/j.1445-5994.2007.01356.x
  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. https://doi.org/10.1159/000322518
  6. Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012;87:1214-1225. https://doi.org/10.1016/j.mayocp.2012.08.013
  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. https://doi.org/10.5664/jcsm.28110
  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. https://doi.org/10.1111/joim.12161
  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. https://doi.org/10.1111/joim.12022
  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. https://doi.org/10.1111/j.1540-8159.2000.tb06760.x
  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. https://doi.org/10.4065/77.6.531
  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. https://doi.org/10.1159/000484205
  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. https://doi.org/10.1016/j.hrthm.2015.03.029
  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. https://doi.org/10.1007/s10286-011-0119-5
  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. https://doi.org/10.1042/CS20110077
  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. https://doi.org/10.1016/j.jash.2016.01.011
  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. https://doi.org/10.1161/JAHA.113.000755
  19. Blitshteyn S, Brook J. Postural tachycardia syndrome (POTS) with anti-NMDA receptor antibodies after human papillomavirus vaccination. Immunol Res 2017;65:282-284. https://doi.org/10.1007/s12026-016-8855-1
  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. https://doi.org/10.1016/j.vaccine.2015.03.098
  22. Blitshteyn S. Postural tachycardia syndrome after vaccination with Gardasil. Eur J Neurol 2010;17:e52. https://doi.org/10.1111/j.1468-1331.2010.03021.x
  23. Blitshteyn S. Postural tachycardia syndrome following human papillomavirus vaccination. Eur J Neurol 2014;21:135-139. https://doi.org/10.1111/ene.12272
  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. https://doi.org/10.2169/internalmedicine.53.3133
  25. Dahan S, Tomljenovic L, Shoenfeld Y. Postural orthostatic tachycardia syndrome (POTS)-a novel member of the autoimmune family. Lupus 2016;25:339-342. https://doi.org/10.1177/0961203316629558
  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. https://doi.org/10.1080/14017431.2017.1355068
  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. https://doi.org/10.1093/europace/euw154
  28. Vernino S, Stiles LE. Autoimmunity in postural orthostatic tachycardia syndrome: current understanding. Auton Neurosci 2018;215:78-82. https://doi.org/10.1016/j.autneu.2018.04.005
  29. Blitshteyn S. Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS). Lupus 2015;24:1364-1369. https://doi.org/10.1177/0961203315587566
  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. https://doi.org/10.1002/acn3.766
  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. https://doi.org/10.1161/JAHA.119.013006
  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. https://doi.org/10.1161/JAHA.119.014084
  33. Zhang Q, Xu B, Du J. Update of individualized treatment strategies for postural orthostatic tachycardia syndrome in children. Front Neurol 2020;11:525. https://doi.org/10.3389/fneur.2020.00525
  34. Joyner MJ. Exercise training in postural orthostatic tachycardia syndrome: blocking the urge to block β-receptors? Hypertension 2011;58:136-137. https://doi.org/10.1161/HYPERTENSIONAHA.111.173872
  35. Wieling W, Colman N, Krediet CP, Freeman R. Nonpharmacological treatment of reflex syncope. Clin Auton Res 2004;14 Suppl 1:i62-i70. https://doi.org/10.1007/s10286-004-1009-x
  36. Grubb BP. Postural tachycardia syndrome. Circulation 2008;117:2814-2817. https://doi.org/10.1161/CIRCULATIONAHA.107.761643
  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. https://doi.org/10.1007/s10286-011-0155-1
  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. https://doi.org/10.1161/CIRCULATIONAHA.108.846501
  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. https://doi.org/10.1007/BF02281112
  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. https://doi.org/10.1111/j.1540-8159.2011.03047.x
  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. https://doi.org/10.1007/s10286-006-0373-0
  42. Miller AJ, Raj SR. Pharmacotherapy for postural tachycardia syndrome. Auton Neurosci 2018;215:28-36. https://doi.org/10.1016/j.autneu.2018.04.008
  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. https://doi.org/10.1007/s13311-018-0612-9
  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. https://doi.org/10.1253/circj.CJ-10-0514