POTS Treatment Report

www.POTSTreatmentReport.com

admin

Hemodynamic Effects of Compression in POTS

https://clinicaltrials.gov/ct2/show/NCT03484273

Hemodynamic Effects of Compression in POTS

ClinicalTrials.gov Identifier: NCT03484273
Recruitment Status : Recruiting
First Posted : March 30, 2018
Last Update Posted : July 27, 2018
See Contacts and Locations
Sponsor:
University of Calgary
Information provided by (Responsible Party):
Dr. Satish Raj, University of Calgary

Study Details Tabular ViewNo Results PostedDisclaimerHow to Read a Study Record
Study Description
Go to sections
Brief Summary:
When an individual with Postural Tachycardia Syndrome (POTS) stands up, their heart rate increases significantly (>30BPM) and they may experience symptoms such as lightheadedness, dizziness, shortness of breath, nausea and mental confusion.

One commonly prescribed treatment for POTS is compression garments. Compression garments squeeze veins to help return blood back to the heart, which may decrease heart rate and symptoms on standing. However, there is little research about the effectiveness of compression in adults with POTS.

In this study, the investigators will use the Lifewrap garment, which compresses the abdomen, pelvis and lower extremities, to evaluate the effectiveness of compression in POTS. The investigators will use a head up tilt (HUT) which will simulate standing. The study participant will participate in 4x 10 minute HUTs wearing 4 different compression configurations:

full abdomen and lower extremity compression
abdominal only compression
leg only compression
No compression
The investigators hypothesize that with full compression, the participant’s heart rate increase from lying down to upright will be lower than when they are not wearing any compression. The investigators will also ask the participant about their symptoms when they are upright.

The results of this study could demonstrate the potential benefits of compression and what configuration is most effective. These findings could rapidly translate to the clinical setting, providing improved care.

Condition or disease Intervention/treatment Phase
Postural Tachycardia Syndrome
Device: LifeWrap Compression Garment
Not Applicable

Show Detailed Description

Study Design
Go to sections
Study Type : Interventional
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Intervention Model Description: There will be 4 compression conditions based on strap configuration of the Lifewrap garment: full abdominal and lower extremity compression, abdominal only compression, lower extremity only compression and no compression. The order of these interventions will be randomized.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Body Compression in Postural Tachycardia Syndrome (POTS): Effects on Orthostatic Tolerance
Actual Study Start Date : July 12, 2018
Estimated Primary Completion Date : March 2020
Estimated Study Completion Date : June 2020
Arms and Interventions
Go to sections
Arm Intervention/treatment
Experimental: Full Compression
The LifeWrap compression garment will be fully secured with all straps.
Device: LifeWrap Compression Garment
Non-Pneumatic Anti-Shock (NASG) compression garment comprised of neoprene with velcro closures.

Experimental: Abdominal and Pelvic Compression
The Lifewrap compression garment abdominal, pelvic and upper thigh straps only will be secured.
Device: LifeWrap Compression Garment
Non-Pneumatic Anti-Shock (NASG) compression garment comprised of neoprene with velcro closures.

Experimental: Lower Limb Compression
The Lifewrap compression garment calf and ankle straps only will be secured.
Device: LifeWrap Compression Garment
Non-Pneumatic Anti-Shock (NASG) compression garment comprised of neoprene with velcro closures.

No Intervention: No Compression
None of the LifeWrap compression garment straps will be secured.

Phase N/A

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome

https://onlinelibrary.wiley.com/doi/abs/10.1111/pace.13441

https://www.ncbi.nlm.nih.gov/pubmed/29989177?dopt=Abstract

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome.

Pacing Clin Electrophysiol

Related Articles

Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome.

Pacing Clin Electrophysiol. 2018 09;41(9):1201-1203

Authors: Kanjwal K, Qadir R, Ruzieh M, Grubb BP

Abstract

INTRODUCTION: We previously reported on a subgroup of postural orthostatic tachycardia syndrome (POTS) patients who may also have features of neurocardiogenic syncope as well. In this subgroup of patients, we found syncope and presyncope were predominant clinical features. To understand the mechanism of syncope in this subgroup, we identified 39 patients who underwent loop recorder insertion.

METHODS: We reviewed charts of 450 patients who had POTS and syncope seen at the University of Toledo Medical Center from 2003 to 2017. Thirty-nine patients had at least four episodes of syncope in the last 6 months and were included for this study. All of these patients had a prior evaluation with a Holter and an event monitor which were inconclusive.

RESULTS: Thirty-nine patients, 33 (85%) women, aged 20-46 years, were included in this study. All patients demonstrated prolonged asystole (>6 seconds) or severe bradycardia (heart rate < 30 beats/min) during their syncope on implantable loop recorder (IRL). Fifteen patients demonstrated an asystole of >10 seconds and also had prolonged and convulsive syncope. All patients had abrupt syncope without any warning sign. All patients underwent dual-chamber pacemaker implantation using a closed loop stimulation algorithm. Syncope were completely eliminated in all patients following pacemaker implantation; however, they continued to have orthostatic tachycardia.

CONCLUSION: POTS patients with unusually frequent syncope should be considered for ILR implantation if other monitoring modalities like 48-hour Holter monitor or event recorder are inconclusive. ILR may identify a subgroup of POTS patients who may benefit from pacemaker implantations.

PMID: 29989177 [PubMed – indexed for MEDLINE]

PubMed:29989177

Moving from the present to the future of Postural Tachycardia Syndrome – What we need

https://www.autonomicneuroscience.com/article/S1566-0702(18)30076-6/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/30539785?dopt=Abstract

Moving from the present to the future of Postural Tachycardia Syndrome – What we need.

Auton Neurosci

Related Articles

Moving from the present to the future of Postural Tachycardia Syndrome – What we need.

Auton Neurosci. 2018 12;215:126-128

Authors: Raj SR, Robertson D

Abstract

Our understanding about Postural Tachycardia Syndrome (POTS) has advanced significantly over the last 25 years. Despite the significant advances that have been made in defining the syndrome and finding some treatments for our patients, there is much work to be done to significantly improve our understanding of the disorder and improve therapeutics. In this article, 5 NEEDS are identified that will be required over the next several years if we want future care to move beyond where we are in the present. These include: (1) a NEED for better administrative data to track POTS diagnoses and the impact of the illness; (2) a NEED to improve physician awareness about POTS, which is a prerequisite for improved access to care; (3) a NEED to better understand the multiple pathophysiologies underlying POTS and the roles of the different medical comorbidities; (4) a NEED for data on effective treatments for POTS; and (5) a NEED for more research funding to study POTS.

PMID: 30539785 [PubMed – indexed for MEDLINE]

PubMed:30539785

Efficacy of Therapies for Postural Tachycardia Syndrome: A Systematic Review and Meta-analysis

https://www.mayoclinicproceedings.org/article/S0025-6196(18)30111-3/fulltext

https://www.sciencedirect.com/science/article/abs/pii/S0025619618301113

https://pubmed.ncbi.nlm.nih.gov/29937049-efficacy-of-therapies-for-postural-tachycardia-syndrome-a-systematic-review-and-meta-analysis/

Efficacy of Therapies for Postural Tachycardia Syndrome: A Systematic Review and Meta-analysis

Abstract
Objective: To identify the evidence base and evaluate the efficacy of each treatment for postural tachycardia syndrome (POTS) in light of a recent consensus statement highlighting the lack of treatment options with clear benefit to risk ratios for this debilitating condition.

Methods: The CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases from inception to May 2017 were searched using the terms postural AND tachycardia AND syndrome. A total of 135 full-text publications were screened after excluding duplicates (n=681), conference abstracts (n=467), and records that did not relate to POTS therapy (n=876). We included 28 studies with at least 4 patients with POTS in which symptomatic response was reported after more than 4 weeks of therapy. This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Two investigators independently performed the data extraction and evaluated the quality of evidence.

Results: This study comprised 25 case series and 3 small randomized controlled trials that evaluated 755 and 103 patients with POTS, respectively. Interventions directed at increasing intravascular volume, increasing peripheral or splanchnic vascular tone, controlling heart rate, and increasing exercise tolerance demonstrate moderate efficacy (range, 51%-72%). Few data exist on their comparative effectiveness. Significant heterogeneities were seen in terms of patient age, symptom severity, and the measures used to evaluate treatment efficacy.

Conclusion: The current evidence base to guide optimal management of patients with POTS is extremely limited. More high-quality collaborative research with standardized reporting of symptom response and treatment tolerability is urgently needed.

Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach

https://www.autonomicneuroscience.com/article/S1566-0702(17)30328-4/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/29519643?dopt=Abstract

Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach.

Auton Neurosci

Related Articles

Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach.

Auton Neurosci. 2018 12;215:56-61

Authors: Strassheim V, Welford J, Ballantine R, Newton JL

Abstract

Fatigue is a significant symptom that is frequently reported by those with postural tachycardia syndrome (PoTS). There are a variety of reasons why those with PoTS might experience fatigue and as a consequence an individualised approach to management is most appropriate. In this chapter we will examine the prevalence of fatigue in those with PoTS, its overlap with conditions such as chronic fatigue syndrome and describe a clinical approach to the management of fatigue in those with PoTS.

PMID: 29519643 [PubMed – indexed for MEDLINE]

PubMed:29519643

POTS UK – Facebook

https://www.facebook.com/POTS-UK-185492778170610/

POTS UK – Facebook

Back to top