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. 2012 Aug;87(8):746-52.
doi: 10.1016/j.mayocp.2012.02.020. Epub 2012 Jul 15.

A prospective, 1-year follow-up study of postural tachycardia syndrome

Kurt Kimpinski  1 , Juan J Figueroa, Wolfgang Singer, David M Sletten, Valeria Iodice, Paola Sandroni, Philip R Fischer, Tonette L Opfer-Gehrking, Jade A Gehrking, Phillip A Low
Affiliations

A prospective, 1-year follow-up study of postural tachycardia syndrome

Kurt Kimpinski et al. Mayo Clin Proc. 2012 Aug.

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.

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Figures

FIGURE
FIGURE
Comparison of heart rate increment on head-up tilt at baseline and 1-year follow-up. Heart rate increment during head-up tilt did not significantly differ at baseline vs the follow-up period (2-related sample Wilcoxon signed rank test, P=.12). Heart rate increment was obtained as the maximum increase with tilt during a 5-minute period.
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