Management of Postural Orthostatic Tachycardia Syndrome in the Absence of Randomized Controlled Trials

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome causing patients to experience light-headedness, palpitations, tremors, and breathlessness upon assuming an upright posture. Despite the absence of available long-term, multicenter, randomized controlled trial data, this literature review aims to concisely present the nonpharmacological and pharmacological interventions that have been used in the treatment of POTS reported to date by cross-sectional studies, cohort studies, and retrospective studies. We attempt to classify treatments as first-, second-, and third-line therapies based on our own experience and available data.

Keywords: Managemen; nonpharmacological; pharmacological; postural orthostatic tachycardia syndrome.

Figure 1:

Summary of first-, second-, and third-line therapies of POTS. Treatment options are proposed in a step-wise approach based on effectiveness and side-effect profile. Nonpharmacologic therapies have the lowest side-effect profile and should be trialed first. These options are followed by second-line therapies, which have well-documented effectiveness as was described in this report. Lastly, third-line therapies are those therapies with early or little effectiveness data or with significant side effects.