tetano
Editor, Senior Moderator
Heart Rhythm
. 2024 Jan;21(1):74-81.
doi: 10.1016/j.hrthm.2023.09.012. Epub 2023 Nov 11. Postural orthostatic tachycardia syndrome after COVID-19 vaccination
Debbie Lin Teodorescu[SUP] 1 [/SUP], Anxhela Kote[SUP] 1 [/SUP], Jewel N Reaso[SUP] 1 [/SUP], Carine Rosenberg[SUP] 1 [/SUP], Xiao Liu[SUP] 1 [/SUP], Alan C Kwan[SUP] 1 [/SUP], Susan Cheng[SUP] 1 [/SUP], Peng-Sheng Chen[SUP] 2 [/SUP]
Affiliations
Background: There is an association between coronavirus disease 2019 (COVID-19) mRNA vaccination and the incidence or exacerbation of postural orthostatic tachycardia syndrome (POTS).
Objective: The purpose of this study was to characterize patients reporting new or exacerbated POTS after receiving the mRNA COVID-19 vaccine.
Methods: We prospectively collected data from sequential patients in a POTS clinic between July 2021 and June 2022 reporting new or exacerbated POTS symptoms after COVID-19 vaccination. Heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) were compared against those of 24 healthy controls.
Results: Ten patients (6 women and 4 men; age 41.5 ± 7.9 years) met inclusion criteria. Four patients had standing norepinephrine levels > 600 pg/mL. All patients had conditions that could raise POTS risk, including previous COVID-19 infection (N = 4), hypermobile Ehlers-Danlos syndrome (N = 6), mast cell activation syndrome (N = 6), and autoimmune (N = 7), cardiac (N = 7), neurological (N = 6), or gastrointestinal conditions (N = 4). HRV analysis indicated a lower ambulatory root mean square of successive differences (46.19 ±24 ms; P = .042) vs control (72.49 ± 40.8 ms). SKNA showed a reduced mean amplitude (0.97 ± 0.052 μV; P = .011) vs control (1.2 ± 0.31 μV) and burst amplitude (1.67 ± 0.16 μV; P = .018) vs control (4. 3 ± 4.3 μV). After 417.2 ± 131.4 days of follow-up, all patients reported improvement with the usual POTS care, although 2 with COVID-19 reinfection and 1 with small fiber neuropathy did have relapses of POTS symptoms.
Conclusion: All patients with postvaccination POTS had pre-existing conditions. There was no evidence of myocardial injuries or echocardiographic abnormalities. The decreased HRV suggests a sympathetic dominant state. Although all patients improved with guideline-directed care, there is a risk of relapse.
Keywords: COVID-19; Chronic orthostatic intolerance; Dysautonomia; Postural orthostatic tachycardia syndrome; SARS-CoV-2; mRNA Vaccine.
. 2024 Jan;21(1):74-81.
doi: 10.1016/j.hrthm.2023.09.012. Epub 2023 Nov 11. Postural orthostatic tachycardia syndrome after COVID-19 vaccination
Debbie Lin Teodorescu[SUP] 1 [/SUP], Anxhela Kote[SUP] 1 [/SUP], Jewel N Reaso[SUP] 1 [/SUP], Carine Rosenberg[SUP] 1 [/SUP], Xiao Liu[SUP] 1 [/SUP], Alan C Kwan[SUP] 1 [/SUP], Susan Cheng[SUP] 1 [/SUP], Peng-Sheng Chen[SUP] 2 [/SUP]
Affiliations
- PMID: 38176772
- DOI: 10.1016/j.hrthm.2023.09.012
Background: There is an association between coronavirus disease 2019 (COVID-19) mRNA vaccination and the incidence or exacerbation of postural orthostatic tachycardia syndrome (POTS).
Objective: The purpose of this study was to characterize patients reporting new or exacerbated POTS after receiving the mRNA COVID-19 vaccine.
Methods: We prospectively collected data from sequential patients in a POTS clinic between July 2021 and June 2022 reporting new or exacerbated POTS symptoms after COVID-19 vaccination. Heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) were compared against those of 24 healthy controls.
Results: Ten patients (6 women and 4 men; age 41.5 ± 7.9 years) met inclusion criteria. Four patients had standing norepinephrine levels > 600 pg/mL. All patients had conditions that could raise POTS risk, including previous COVID-19 infection (N = 4), hypermobile Ehlers-Danlos syndrome (N = 6), mast cell activation syndrome (N = 6), and autoimmune (N = 7), cardiac (N = 7), neurological (N = 6), or gastrointestinal conditions (N = 4). HRV analysis indicated a lower ambulatory root mean square of successive differences (46.19 ±24 ms; P = .042) vs control (72.49 ± 40.8 ms). SKNA showed a reduced mean amplitude (0.97 ± 0.052 μV; P = .011) vs control (1.2 ± 0.31 μV) and burst amplitude (1.67 ± 0.16 μV; P = .018) vs control (4. 3 ± 4.3 μV). After 417.2 ± 131.4 days of follow-up, all patients reported improvement with the usual POTS care, although 2 with COVID-19 reinfection and 1 with small fiber neuropathy did have relapses of POTS symptoms.
Conclusion: All patients with postvaccination POTS had pre-existing conditions. There was no evidence of myocardial injuries or echocardiographic abnormalities. The decreased HRV suggests a sympathetic dominant state. Although all patients improved with guideline-directed care, there is a risk of relapse.
Keywords: COVID-19; Chronic orthostatic intolerance; Dysautonomia; Postural orthostatic tachycardia syndrome; SARS-CoV-2; mRNA Vaccine.