Long-Term Outcomes of Children and Adolescents With Postural Tachycardia Syndrome After Conventional Treatment

Tao, Chunyan; Lu, Wenxin; Lin, Jing; Li, Hongxia; Li, Xueying; Tang, Chaoshu; Du, Junbao; Jin, Hang

doi:10.3389/fped.2019.00261

Cited by 19 publications

(16 citation statements)

References 31 publications

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“…Therefore, our outcomes measures were for relatively short-term outcomes only and do not preclude subsequent worsening or improvement in the long term. Overall, 59.3% of patients improved and 10.7% of patients reported resolution of their symptoms on initial follow-up which is slightly lower than previously reported 15,46 improvement rates of about 86%, but this rate of improvement was seen in long-term rather than short-term follow-up. An important POTS therapy that we did not assess in our cohort is exercise, which has been shown to have significant promise in the treatment of POTS.…”

Section: Medical Management and Outcomescontrasting

confidence: 64%

Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center

2020

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Aim: We characterize the pediatric postural orthostatic tachycardia syndrome (POTS) population seen at a single tertiary care referral center. Method: Retrospective chart review of all pediatric POTS patients seen in our center between 2015 and 2017. Pediatric POTS was defined as chronic, at least 3 months, symptoms of orthostatic intolerance associated with excessive orthostatic tachycardia as determined by tilt table testing with orthostatic heart rate increment of ≥40 bpm within 5 minutes of head-up tilt or absolute orthostatic heart rate ≥130 bpm for patients 13 years old and younger and ≥120 bpm for those 14 years and older. We looked at demographics, presenting symptoms, comorbidities, examination findings, investigation findings, treatment, and patient reported outcomes. Outcome measures were separated by patient report and group comparisons were made using 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. Results: One hundred thirty-four patients with pediatric onset POTS were identified. The mean age was 15 years. Seventy-nine percent of patients were female and 90% were white. The most common presenting symptoms included dizziness/lightheadedness (88%), syncope (54%), and palpitations (40%). Many patients had significant comorbidities attributable to numerous bodily systems, most commonly headache syndromes (migraine 43%, nonspecific headache 22%, chronic daily headache 14%, and new daily persistent headache 5%) and chronic fatigue (60%). Low vitamin D and insufficient iron stores were commonly seen. The majority of patients improved or had resolution of symptoms following treatment (70%). When separated by outcome, statistically significant differences were found for glucose (patients whose symptoms resolved had higher median glucose), palpitations (patients whose symptoms resolved were less likely to have palpitations), constipation (patients whose symptoms were stable/worsened were more likely to have constipation), and unexplained pain (patients whose symptoms were stable/worsened were more likely to have unexplained pain). Conclusions: Pediatric POTS is a chronic condition with a fairly good prognosis following appropriate treatment. It is associated with numerous comorbidities that necessitate multidisciplinary expert care.

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Section: Medical Management and Outcomescontrasting

confidence: 64%

Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center

2020

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“…However, there are minimal data showing clinically significant improvements with the use of medications. Via clinical review articles and anecdotal experience with some general outcome data, 5,6 many patients are improving with treatment; however, the use of medications has not yet been fully studied. More data on pharmacologic management of patients with POTS are needed.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

“…2 Although POTS can be debilitating, most patients improve or fully recover. 5,6 Although the etiology and the pathophysiologic mechanisms of POTS are heterogenous and not completely understood, several physiologic characteristics point toward a few mechanistic pathways contributing to the illness. First, intravascular hypovolemia explains symptoms of POTS well and is evidenced by the response of a large proportion of patients to treatment with fluid expansion.…”

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confidence: 99%

Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review

et al. 2020

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Purpose: Postural orthostatic tachycardia syndrome has been recognized for decades, but treatment is largely based on anecdotal experience and expert opinion. Pharmacologic treatment is inconsistent and unstandardized. We did a systematic review to identify controlled studies from which informed treatment decisions can be made. Method: Through a standard systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified all English-language studies of a medication treatment for postural orthostatic tachycardia syndrome that included a comparison or control group and followed outcomes for at least 1 week of treatment. Results: A total of 626 studies were identified by the search criteria, and 8, involving a total of 499 patients, met the criteria. No studies were adequately similar to allow for meta-analysis. Of the identified 8 studies, 2 were randomized controlled trials and 4 had been subjected to peer review. In individual studies, there was some favorable effect with fludrocortisone, beta blockers, midodrine, and selective serotonin reuptake inhibitors. Conclusion: There is a paucity of high-quality data about effectiveness of medication in the treatment of postural orthostatic tachycardia syndrome. Nonetheless, 2 randomized trials and 6 other reports show some favorable effects of medication.

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“… 3 Tao et al followed up a group of children with POTS for 6 years and showed a cumulative asymptomatic rate of 85.6%. 4 These above reports suggest that the prognosis of pediatric POTS is generally benign. At present, the reported comorbidities in children with POTS mainly include allergic disorders, migraine, psychological disorders, hyperventilation syndrome, chronic fatigue syndrome, hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder (hEDS/HSD), gastrointestinal dysfunction, and fibromyalgia.…”

Section: Introductionmentioning

confidence: 96%

Impact of Comorbidities on the Prognosis of Pediatric Postural Tachycardia Syndrome

Wang¹,

Du²,

Li³

et al. 2021

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Objective To investigate the influence of comorbidities on the prognosis of pediatric postural tachycardia syndrome (POTS). Methods In this retrospective cohort study, 275 children with POTS admitted to the Department of Pediatrics at Peking University First Hospital were recruited from 2016 to 2019 and followed up. The participants were divided into simple POTS (S-POTS, n=156 cases) and POTS with comorbidities (Co-POTS, n=119 cases) groups according to whether they were complicated with comorbidities. A Cox regression analysis was used to identify the prognostic risk factors for children with POTS, while Kaplan–Meier curves were applied to compare the cumulative symptom remission rate (CSRR) between the two groups. The rehospitalization of the children between the two groups was also compared to explore the influence of comorbidities. Results Twenty-one participants (7.6%) were lost during a median follow-up of 24 months. The Cox regression model showed that comorbidities and body mass index (BMI) were associated with the CSRR of the children with POTS. The CSRR of pediatric POTS alone was 1.748 times higher than that of patients with comorbidities, and the CSRR was decreased by 5.1% for each 1 kg/m 2 increase in BMI. The most common comorbidity in children with POTS in this study was allergic disorders, followed by the psychological diseases. The patients in the Co-POTS group had a lower CSRR than those in the S-POTS group (log rank P=0.0001). In addition, compared with those of the S-POTS group, the total number of rehospitalizations was high (P=0.001), and the total hospital stays were long in the Co-POTS group (P<0.001). Conclusion Complicating with comorbidities, pediatric patients with POTS had lower CSRR and more rehospitalizations than those without comorbidities. More attention should be given to comorbidities when managing pediatric POTS.

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Long-Term Outcomes of Children and Adolescents With Postural Tachycardia Syndrome After Conventional Treatment

Cited by 19 publications

References 31 publications

Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center

Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center

Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review

Impact of Comorbidities on the Prognosis of Pediatric Postural Tachycardia Syndrome

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