Diurnal Heart Rate Patterns in Inappropriate Sinus Tachycardia

Rubenstein, Jason; Freher, Mark; Kadish, Alan H.; Goldberger, Jeffrey J.

doi:10.1111/j.1540-8159.2010.02725.x

Cited by 12 publications

(16 citation statements)

References 27 publications

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“…Continuous ambulatory HR monitoring has previously shown that HR undergoes diurnal variation [17,24]. HR was maximal in the morning (10 am) with a subsequent progressive decline throughout the day until a nadir in the early morning hours just prior to waking, after which HR begins to rise again [17]. This variability might be an adaptive advantage to allow the human to rise in the morning to meet the challenges of a new day.…”

Section: Discussionmentioning

confidence: 99%

“…Blood pressure and heart rate exhibit considerable variation over a 24-hour period[3–5,9,17,24] as a result of diurnal variations in emotional and behavioral states[18,22], baroreflex sensitivity[5,13], renin-angiotensin system activity[23], plasma catecholamine levels[4,23], and adrenergic tone[11]. The measurement of blood pressure and heart rate in the supine and standing positions forms the basis of orthostatic testing, which is crucial to the evaluation of a number of neurocardiogenic disorders including syncope, autonomic failure, and POTS [12,26].…”

Section: Introductionmentioning

confidence: 99%

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Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome

et al. 2011

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Patients with Postural Tachycardia Syndrome (POTS) have excessive orthostatic tachycardia (>30 bpm) when standing from a supine position. Heart rate (HR) and blood pressure (BP) are known to exhibit diurnal variability, but the role of diurnal variability in orthostatic changes of HR & BP is not known. In this study, we tested the hypothesis that there is diurnal variation of orthostatic HR & BP in patients with POTS and healthy controls. Patients with POTS (n=54) and healthy volunteers (n=26) were admitted to the Clinical Research Center. Supine and standing (5 min) HR & BP were obtained on the evening on the day of admission and in the following morning. Overall, standing HR was significantly higher in the morning than the evening (102±3 bpm [AM] vs. 93±2 bpm [PM]; P<0.001). Standing HR was higher in the morning in both POTS patients (108±4 bpm [AM] vs. 100±3 bpm [PM]; P=0.012) and controls (89±3 bpm [AM] vs. 80±2 bpm [PM]; P=0.005), when analyzed separately. There was no diurnal variability in orthostatic BP in POTS. More subjects met the POTS HR criterion in the morning compared with the evening (P=0.008). There was significant diurnal variability in orthostatic tachycardia, with a great orthostatic tachycardia in the morning compared to the evening in both patients with POTS and healthy subjects. Given the importance of orthostatic tachycardia in diagnosing POTS, this diurnal variability should be considered in the clinic as it may affect the diagnosis of POTS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome

et al. 2011

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“…IST is a diagnosis of exclusion, requiring that other causes of sinus tachycardia be investigated. IST is often difficult to identify and treat, particularly given the multiple underlying pathophysiologic processes . IST seems to be more prevalent in women, and in particular, women who are employed within healthcare .…”

Section: Introductionmentioning

confidence: 99%

Epicardial/Endocardial Sinus Node Ablation After Failed Endocardial Ablation for the Treatment of Inappropriate Sinus Tachycardia

Jacobson

Kraus

Lee

et al. 2013

Cardiovasc electrophysiol

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“…An alternative explanation for the time‐related HR reduction in POTS with placebo is a background cardiovascular variability unrelated to therapy. Blood pressure (BP) and HR are known to exhibit significant diurnal variability over a 24 h period, with an increase in these measures in the early morning that is associated with sympathetic activation . Furthermore, numerous cardiovascular events, such as myocardial ischaemia, stroke and arrhythmia, exhibit some degree of circadian variability, with a peak in event rates in the early morning …”

Section: Introductionmentioning

confidence: 99%

“…Blood pressure (BP) and HR are known to exhibit significant diurnal variability over a 24 h period, with an increase in these measures in the early morning that is associated with sympathetic activation. [13][14][15] Furthermore, numerous cardiovascular events, such as myocardial ischaemia, stroke and arrhythmia, exhibit some degree of circadian variability, with a peak in event rates in the early morning. [16][17][18] To determine which of these possibilities may best explain the decrease in standing HR with placebo over time, we performed a prospective randomized cross-over trial comparing an open-label no treatment (NoRx) intervention with a blinded placebo in POTS patients.…”

Section: Introductionmentioning

confidence: 99%

Understanding the placebo effect in clinical trials for postural tachycardia syndrome

Nwazue

Arnold

Raj

et al. 2014

Clin Exp Pharma Physio

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Postural tachycardia syndrome (POTS) is characterized by excessive increases in heart rate (HR) upon standing. Previous studies have shown that standing HR decreases over time in POTS patients given placebo. We hypothesized that this reduction is due to cardiovascular physiological alteration, as opposed to psychological benefit from perceived therapy. To prospectively test this hypothesis, we examined the effects of an open-label "No Treatment" intervention (NoRx) compared to a patient-blinded placebo on standing HR in POTS patients. Twenty-one POTS patients participated in a randomized, crossover trial with oral placebo versus NoRx administered at 9 AM. Seated blood pressure (BP) and HR were measured at baseline and every hour for 4 hours (h). Similarly, BP and HR were measured while patients stood for 10 minutes at these time points. Standing HR significantly decreased over time with both NoRx (baseline: 112 ± 13 bpm, 4h: 103 ± 16 bpm) and placebo (baseline: 112 ± 14 bpm, 4h: 102 ± 16 bpm; Ptime<0.001), but this effect was not different between interventions (Pdrug=0.771). POTS patients have exaggerated orthostatic tachycardia in the morning that decreases over time with either placebo or NoRx interventions, suggesting this phenomenon is due to cardiovascular physiologic variation. These data highlight the need for a placebo arm in hemodynamic clinical trials in POTS, and may have important implications for diagnosis of these patients.

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Diurnal Heart Rate Patterns in Inappropriate Sinus Tachycardia

Abstract: Patients with IAST and elevated average daily HR exhibit normal diurnal variation around a higher mean HR. In contrast, patients with IAST and lower average daily HR had an exaggerated morning rise in HR. These diurnal patterns may be useful to classify the pathophysiology of IAST.

Cited by 12 publications

References 27 publications

Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome

Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome

Epicardial/Endocardial Sinus Node Ablation After Failed Endocardial Ablation for the Treatment of Inappropriate Sinus Tachycardia

Understanding the placebo effect in clinical trials for postural tachycardia syndrome

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