Effects of intermittent intravenous saline infusions in patients with medication—refractory postural tachycardia syndrome

Background: Ivabradine is a selective I f channel blocker that reduces heart rate without affecting other cardiovascular functions. In case reports and case series, it was shown to improve symptoms in patients with postural tachycardia syndrome (POTS). Methodology and results:This retrospective study examined patients who were diagnosed with POTS and received ivabradine as part of their treatment. Forty-nine patients (47 females, 95.9%) received ivabradine. The average age was 35.1 ± 10.35 years. The most common symptoms were palpitations and lightheadedness and both improved significantly, 88.4% and 76.1% response rate, respectively. A total of 38 patients reported improvement in their symptoms. In addition, ivabradine resulted in an objective decrease in sitting and standing heart rate (78.1 ± 10.7 vs 72.5 ± 7.6, P-value: 0.01) and (107.4 ± 14.1 vs 95.1 ± 13.7, P-value: < 0.001), respectively, with no significant change in blood pressure. The most common reported side effect was luminous phenomena/visual brightness occurring in nine patients. However, none of the patients stopped ivabradine due to side effects. Conclusion:Our study shows that ivabradine is likely to be effective in treating patients with POTS. Nearly 78% of our cohort reported a significant improvement in symptoms with no major adverse effects reported. A future randomized, placebo-controlled trial is warranted.

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“…As with our previous experience, 6 there was a female predominance (95.9% female), and the average age of patients studied was 35.1 ±…”

Section: Discussionsupporting

confidence: 80%

Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience

Ruzieh

Sirianni

Ammari

et al. 2017

Pacing Clinical Electrophis

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“…observed a significant decrease in systemic vascular conductance in a mixed sex group (Kiviniemi et al. ); however, using only 30% MVC HG exercise Incognito et al. did not observe a change in total vascular conductance during PECO in men (Incognito et al.…”

Section: Discussionmentioning

confidence: 96%

Sex differences in the ventilatory and cardiovascular response to supine and tilted metaboreflex activation

Joshi

Edgell

2019

Physiol Rep

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Women have attenuated exercise pressor responses compared to men; however, their cerebrovascular and ventilatory responses have not been previously measured. Furthermore, recent evidence has shown that posture change can influence the response of the metaboreflex but this has only been tested in men. Young and healthy men ( n = 14; age: 21 ± 2) and women ( n = 11; age: 19 ± 1) underwent 40% MVC static handgrip exercise ( HG ) for 2 min followed by 3 min of post‐exercise circulatory occlusion ( PECO ) in the supine and 70° tilted postures. In supine position during HG and PECO only men had an increase in ventilation (Men: Baseline: 12.5 ± 1.7 L/min, HG : 18.6 ± 5.3 L/min, PECO : 17.7 ± 10.3 L/min; Women: Baseline: 12.0 ± 1.5 L/min, HG : 12.4 ± 1.2 L/min, PECO : 11.5 ± 1.3 L/min; Sex × Time interaction P = 0.037). In supine position during HG and PECO men and women had similar reductions in cerebrovascular conductance (Men: Baseline: 0.79 ± 0.13 cm/sec/mmHg, HG : 0.68 ± 0.18 cm/sec/mmHg, PECO : 0.61 ± 0.19 cm/s/mmHg; Women: Baseline: 0.87 ± 0.13 cm/sec/mmHg, HG : 0.83 ± 0.14 cm/sec/mmHg, PECO : 0.75 ± 0.17 cm/sec/mmHg; P < 0.015 HG / PECO vs. baseline). When comparing the response to PECO in the supine versus upright postures there was a significant attenuation in the increase in mean arterial pressure in both men and women (Supine posture: Men: +23.3 ± 14.5 mmHg, Women: +12.0 ± 7.3 mmHg; Upright posture: Men: +15.7 ± 14.1 mmHg, Women: +7.7 ± 6.7 mmHg; Main effect of sex P = 0.042, Main effect of posture P < 0.001). Our results indicate sexually dimorphic ventilatory responses to HG and PECO which could be due to different interactions of the metaboreflex and chemoreflex. We have also shown evidence of attenuated metaboreflex function in the upright posture in both men and women.

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“…normal saline infusions. 33,34 These data are from acute randomized, controlled trials, or retrospective noncontrolled series. There are no medium-term or long-term randomized controlled trials of pharmacological therapy for POTS.…”

Section: Pharmacological Management Of Potsmentioning

confidence: 99%

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Raj

Guzmán

Harvey

et al. 2020

Canadian Journal of Cardiology

135

169

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Effects of intermittent intravenous saline infusions in patients with medication—refractory postural tachycardia syndrome

Abstract: Intermittent IV infusions of saline dramatically reduce symptoms and improve quality of life in patients suffering from POTS. Further work should explore its efficacy as a bridge study for patients of high symptomatic severity.

Cited by 32 publications

References 23 publications

Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience

Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience

Sex differences in the ventilatory and cardiovascular response to supine and tilted metaboreflex activation

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

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