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Raising the bar in postural orthostatic tachycardia syndrome research: Evidence and challenges

  • Marie-Claire Seeley
    Affiliations
    Centre for Heart Rhythm Disorders, University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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  • Dennis H. Lau
    Correspondence
    Corresponding author at: Centre for Heart Rhythm Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
    Affiliations
    Centre for Heart Rhythm Disorders, University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
    Search for articles by this author
Published:February 22, 2021DOI:https://doi.org/10.1016/j.autneu.2021.102790
      Postural orthostatic tachycardia syndrome (POTS) is a heterogenous condition of autonomic dysregulation that remains a diagnostic challenge to many physicians, leading to delays in diagnosis and suboptimal treatment in many sufferers of this debilitating condition (
      • Shaw B.H.
      • Stiles L.E.
      • Bourne K.
      • Green E.A.
      • Shibao C.A.
      • Okamoto L.E.
      • Garland E.M.
      • Gamboa A.
      • Diedrich A.
      • Raj V.
      • Sheldon R.S.
      • Biaggioni I.
      • Robertson D.
      • Raj S.R.
      The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey.
      ). Various descriptions of POTS-like illnesses have appeared throughout medical literature dating back to the late 19th century (
      • Da Costa J.M.
      On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences.
      ). However, it wasn't until 1993 that Schondorf and Low proposed the first diagnostic criteria for the syndrome (
      • Schondorf R.
      • Low P.A.
      Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
      ). Subsequent iterations of this criteria have resulted in the largely accepted current diagnostic criteria for POTS, namely: a heart rate rise ≥30 bpm (≥40 bpm for adolescents) sustained on standing for 10 min and in the absence of postural hypotension. In addition, there is a consensus that symptomology of orthostatic intolerance should be present for at least three months and should not be attributable to another primary condition (
      • Freeman R.
      • Wieling W.
      • Axelrod F.B.
      • Benditt D.G.
      • Benarroch E.
      • Biaggioni I.
      • Cheshire W.P.
      • Chelimsky T.
      • Cortelli P.
      • Gibbons C.H.
      • Goldstein D.S.
      • Hainsworth R.
      • Hilz M.J.
      • Jacob G.
      • Kaufmann H.
      • Jordan J.
      • Lipsitz L.A.
      • Levine B.D.
      • Low P.A.
      • Mathias C.
      • Raj S.R.
      • Robertson D.
      • Sandroni P.
      • Schatz I.J.
      • Schondorf R.
      • Stewart J.M.
      • van Dijk J.G.
      Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.
      ;
      • Raj S.R.
      • Guzman J.C.
      • Harvey P.
      • Richer L.
      • Schondorf R.
      • Seifer C.
      • Thibodeau-Jarry N.
      • Sheldon R.S.
      Canadian cardiovascular society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance.
      ;
      • Sheldon R.S.
      • Grubb II, B.P.
      • Olshansky B.
      • Shen W.K.
      • Calkins H.
      • Brignole M.
      • Raj S.R.
      • Krahn A.D.
      • Morillo C.A.
      • Stewart J.M.
      • Sutton R.
      • Sandroni P.
      • Friday K.J.
      • Hachul D.T.
      • Cohen M.I.
      • Lau D.H.
      • Mayuga K.A.
      • Moak J.P.
      • Sandhu R.K.
      • Kanjwal K.
      2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
      ). In the special issue of this Journal for the silver anniversary for POTS, five major needs were identified towards improving future care of POTS (
      • Raj S.R.
      • Robertson D.
      Moving from the present to the future of postural tachycardia syndrome - what we need.
      ): 1) Improved understanding of POTS pathophysiology; 2) Improved data on POTS prevalence and its impact on sufferers; 3) Improved physician awareness for POTS diagnosis and access to care; 4) Improved studies on effective treatments for POTS; 5) Improved research funding for POTS. Indeed, there is an urgent need for well-conducted collaborative research to address the many gaps identified surrounding management of this complex condition (
      • Lau D.H.
      • Mahajan R.
      • Lee G.
      • Kalman J.M.
      • Sanders P.
      Towards improved care of Postural Tachycardia Syndrome, inappropriate sinus tachycardia and vasovagal syncope patients: a call to action in Australia.
      ).
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