Abstract
Objective
To identify the evidence base and evaluate the efficacy of each treatment for postural
tachycardia syndrome (POTS) in light of a recent consensus statement highlighting
the lack of treatment options with clear benefit to risk ratios for this debilitating
condition.
Methods
The CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases
from inception to May 2017 were searched using the terms postural AND tachycardia AND syndrome. A total of 135 full-text publications were screened after excluding duplicates (n=681),
conference abstracts (n=467), and records that did not relate to POTS therapy (n=876).
We included 28 studies with at least 4 patients with POTS in which symptomatic response
was reported after more than 4 weeks of therapy. This review was performed according
to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
statement. Two investigators independently performed the data extraction and evaluated
the quality of evidence.
Results
This study comprised 25 case series and 3 small randomized controlled trials that
evaluated 755 and 103 patients with POTS, respectively. Interventions directed at
increasing intravascular volume, increasing peripheral or splanchnic vascular tone,
controlling heart rate, and increasing exercise tolerance demonstrate moderate efficacy
(range, 51%-72%). Few data exist on their comparative effectiveness. Significant heterogeneities
were seen in terms of patient age, symptom severity, and the measures used to evaluate
treatment efficacy.
Conclusion
The current evidence base to guide optimal management of patients with POTS is extremely
limited. More high-quality collaborative research with standardized reporting of symptom
response and treatment tolerability is urgently needed.
Abbreviations and Acronyms:
bid (twice daily), CNHSQ (Children's National Health System Questionnaire), EPO (erythropoietin), FeSo4 (ferrous sulfate 300 mg tid), IM (intramuscular), IV (intravenous), LAR (long-acting release), NA (not available), OD (once daily), OHQ (Orthostatic Hypotension Questionnaire), POTS (postural tachycardia syndrome), QOL (quality of life), RCT (randomized controlled trial), SC (subcutaneous), SF-36 (36-item Short-Form Health Survey), SQ(10), SQ (14), SQ (28) (symptom questionnaire rating 10, 14, and 28 symptoms, respectively), SR (slow release), tid (3 times per day), WFDI (Walker Functional Disability Inventory), WSS (Winker symptom scale)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 21, 2018
Footnotes
Grant Support: Dr Wells is supported by scholarships from the National Health and Medical Research Council of Australia (NHMRC) and the Australian Government Research Training Program. Dr Elliott is supported by an early career fellowship from the Heart Foundation of Australia (HFA). Dr Mahajan is supported by a postdoctoral fellowship from the NHMRC and the HFA. Dr Page is supported by a University of Adelaide Beacon Research Fellowship. Dr Sanders is supported by a practitioner fellowship from the NHMRC. Dr Lau is supported by a Robert J. Craig Lectureship from the University of Adelaide.
Potential Competing Interests: Dr Mahajan has served on the advisory board of Boston Scientific and has received research funding from Medtronic and St Jude Medical. Dr Sanders has served on the advisory boards of Biosense Webster, Medtronic, CathRx, and St Jude Medical; has received lecture or consulting fees from Biosense Webster, Medtronic, St Jude Medical, and Boston Scientific; and has received research funding from Medtronic, St Jude Medical, Boston Scientific, Biotronik, and Sorin. Dr Lau has received lecture or consulting fees from St Jude Medical, Boehringer Ingelheim, Bayer, and Pfizer.
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© 2018 Mayo Foundation for Medical Education and Research
