Advertisement
Mayo Clinic Proceedings Home

A Prospective, 1-Year Follow-up Study of Postural Tachycardia Syndrome

      Abstract

      Objective

      To prospectively evaluate patients who met standard criteria for postural tachycardia syndrome (POTS), at baseline and 1-year follow-up, using standard clinical and laboratory methods to assess autonomic function.

      Methods

      Fifty-eight patients met the study criteria (orthostatic symptoms and a heart rate increment of ≥30 beats/min on head-up tilt) and completed 12 months of follow-up. All patients were enrolled and completed the study from January 16, 2006, through April 15, 2009. Patients underwent standardized autonomic testing, including head-up tilt, clinical assessment, and validated questionnaires designed to determine the severity of autonomic symptoms.

      Results

      Patients were predominantly young females (n=49, 84%), with 20 patients (34%) reporting an antecedent viral infection before onset of symptoms. More than one-third (37%) no longer fulfilled tilt criteria for POTS on follow-up, although heart rate increment on head-up tilt did not differ significantly at 1 year (33.8±15.1 beats/min) compared with baseline (37.8±14.6 beats/min) for the entire cohort. Orthostatic symptoms improved in most patients. Autonomic dysfunction was mild as defined by a Composite Autonomic Severity Score of 3 or less in 55 patients (95%) at baseline and 48 patients (92%) at 1 year.

      Conclusion

      To our knowledge, this is the first prospective study of the clinical outcomes of patients with POTS. Orthostatic symptoms improved in our patients, with more than one-third of patients no longer fulfilling tilt criteria for POTS, although the overall group change in heart rate increment was modest. Our data are in keeping with a relatively favorable prognosis in most patients with POTS.

      Abbreviations and Acronyms:

      CASS (Composite Autonomic Severity Score), COMPASS (Composite Autonomic Symptom Score), HUT (head-up tilt), POTS (postural tachycardia syndrome)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Low P.A.
        • Opfer-Gehrking T.L.
        • Textor S.C.
        • et al.
        Comparison of the postural tachycardia syndrome (POTS) with orthostatic hypotension due to autonomic failure.
        J Auton Nerv Syst. 1994; 50: 181-188
        • Thieben M.J.
        • Sandroni P.
        • Sletten D.M.
        • et al.
        Postural orthostatic tachycardia syndrome: the Mayo Clinic experience.
        Mayo Clin Proc. 2007; 82: 308-313
        • Jacob G.
        • Costa F.
        • Shannon J.R.
        • et al.
        The neuropathic postural tachycardia syndrome.
        N Engl J Med. 2000; 343: 1008-1014
        • Low P.A.
        • Sandroni P.
        • Joyner M.J.
        • Shen W.K.
        Postural tachycardia syndrome (POTS).
        J Cardiovasc Electrophysiol. 2009; 20: 352-358
        • Raj S.R.
        • Biaggioni I.
        • Yamhure P.C.
        • et al.
        Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome.
        Circulation. 2005; 111: 1574-1582
        • Schondorf R.
        • Low P.A.
        Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
        Neurology. 1993; 43: 132-137
        • Sandroni P.
        • Opfer-Gehrking T.L.
        • McPhee B.R.
        • Low P.A.
        Postural tachycardia syndrome: clinical features and follow-up study.
        Mayo Clin Proc. 1999; 74: 1106-1110
        • Jordan J.
        • Shannon J.R.
        • Diedrich A.
        • Black B.K.
        • Robertson D.
        Increased sympathetic activation in idiopathic orthostatic intolerance: role of systemic adrenoreceptor sensitivity.
        Hypertension. 2002; 39: 173-178
        • Low P.A.
        • Sandroni P.
        • Joyner M.J.
        • Shen W.K.
        Postural tachycardia syndrome.
        in: Low P.A. Benarroch E.E. Clinical Autonomic Disorders. 3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA2008: 515-533
        • Low P.A.
        • Opfer-Gehrking T.L.
        The autonomic laboratory.
        Am J Electroneurodiagnostic Technol. 1999; 39: 65-76
        • Low P.A.
        Testing the autonomic nervous system.
        Semin Neurol. 2003; 23: 407-421
        • Low P.A.
        • Denq J.C.
        • Opfer-Gehrking T.L.
        • Dyck P.J.
        • O'Brien P.C.
        • Slezak J.M.
        Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects.
        Muscle Nerve. 1997; 20: 1561-1568
        • Low P.A.
        Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure.
        Mayo Clin Proc. 1993; 68: 748-752
        • Suarez G.A.
        • Opfer-Gehrking T.L.
        • Offord K.P.
        • Atkinson E.J.
        • O'Brien P.C.
        • Low P.A.
        The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms.
        Neurology. 1999; 52: 523-528
        • El-Sayed H.
        • Hainsworth R.
        Salt supplementation increases plasma volume and orthostatic tolerance in patients with unexplained syncope.
        Heart. 1996; 75: 134-140
        • Freeman R.
        • Lirofonis V.
        • Farquhar W.B.
        • Risk M.
        Limb venous compliance in patients with idiopathic orthostatic intolerance and postural tachycardia.
        J Appl Physiol. 2002; 93: 636-644
        • Stewart J.M.
        Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects.
        Circulation. 2002; 105: 2274-2281