Postural Tachycardia Syndrome and Inappropriate Sinus Tachycardia: Role of Autonomic Modulation and Sinus Node Automaticity
Open accessAbstract
Background: Inappropriate sinus tachycardia ( IST ) and postural tachycardia syndrome ( POTS ) are 2 disorders characterized by sinus tachycardia. It is debated whether the pathophysiology of IST and POTS results from abnormal autonomic regulation or abnormal sinus node function. We hypothesized that intrinsic heart rate ( IHR ) after autonomic blockade would be increased in patients with IST but not POTS . Methods and Results: We enrolled 48 POTS patients, 8 IST patients, and 17 healthy control ( HC ) subjects. Intravenous propranolol and atropine were given to block the sympathetic and parasympathetic limbs of the autonomic nervous system in order to determine the IHR . Patients with IST have a higher sympathetic contribution to heart rate when compared with POTS patients (31±13 bpm versus 12±7 bpm, P <0.001) and HC (8±4 bpm; P <0.001) and a trend to less parasympathetic contribution than POTS and HC ( IST : 31±11 bpm versus POTS : 46±11 bpm versus HC : 48±11 bpm, ANOVA P =0.108). IHR was not significantly different between IST and either POTS or HC ( IST : 111±11 bpm versus POTS : 108±11 bpm versus HC : 106±12 bpm, ANOVA P =0.237). Conclusions: IST patients have more sympathetic tone when compared with either POTS or HC , but IST patients do not have abnormal sinus node automaticity. These data suggest that the treatment of IST and POTS should focus on sympatholysis, reserving sinus node modification for patients with continued debilitating symptoms after beta‐blockade and possibly ivabradine. Clinical Trial Registration: URL: http://clinicaltrials.gov/ . Unique identifier: NCT00262470.
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In a study by Nwazue et al., IST patients had higher sympathetic contribution to heart rate than POTS patients, but there was no difference in vagal activation between groups.
“IST patients had higher sympathetic contribution to heart rate vs. POTS patients, but there was no difference in vagal activation between groups.”
From Inappropriate sinus tachycardia (2019) · cites this paper as [8]
The Results (Patient Characteristics) confirm a higher sympathetic contribution to heart rate in IST than POTS. They also report a smaller vagal contribution in IST before adjustment; that difference was no longer statistically significant after adjustment for age and BMI. The claim’s unqualified statement that there was no difference omits this distinction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe intrinsic heart rate does not differ between POTS and IST patients.
“The intrinsic HR does not differ between POTS & IST patients [41].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [41]
In POTS, the orthostatic change in heart rate surpasses that in inappropriate sinus tachycardia.
“In POTS, the orthostatic change in HR surpasses that in IST.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [41]
A more recent study of 8 patients with IST compared with 48 patients with POTS and 17 control patients did not show elevated intrinsic heart rates following autonomic blockade to suggest increased sinus node automaticity.
“In contrast, a more recent study of 8 patients with IST compared with 48 patients with POTS and 17 control patients did not show elevated intrinsic heart rates following autonomic blockade to suggest increased sinus node automaticity.58”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [58]
Studies of patients with IST demonstrated, through pharmacologic autonomic blockade, that sympathetic tone is elevated in IST.
“These studies demonstrated, through pharmacologic autonomic blockade, that sympathetic tone is elevated in IST.57,58”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [58]
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- Authors
- Nwazue, V. C., Paranjape, S. Y., Black, B. K., Biaggioni, I., Diedrich, A., Dupont, W. D., Robertson, D., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- Venue
- Journal of the American Heart Association
- Published
- 2014-03-24
- Volume
- 3
- Issue
- 2
- Pages
- e000700-e000700
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC4187519
- OpenAlex
- W2151432514
- Cited by
- 53
- References
- 36
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 7 · 2021: 2 · 2020: 3 · 2019: 6 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 7 · 2014: 2
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Vanderbilt University
- National Institutes of Health (UL1TR000445)
- National Heart, Lung, and Blood Institute (P01HL056693, R01HL102387)
- National Institute of Neurological Disorders and Stroke (U54NS065736)
- NIH Clinical Center
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- postural orthostatic tachycardia syndrome, inappropriate sinus tachycardia, autonomic nervous system, sinus node automaticity, intrinsic heart rate, propranolol, atropine, sympathetic tone, parasympathetic activity, sympatholysis, beta-adrenergic blockade, ivabradine
- MeSH terms
- Adult, Blood Pressure, Female, Heart Rate, Humans, Male, Middle Aged, Parasympathetic Nervous System, Parasympatholytics, Periodicity, Sinoatrial Node, Sympathetic Nervous System, Sympatholytics, Tachycardia, Sinus, Time Factors, Case-Control Studies, Postural Orthostatic Tachycardia Syndrome, Young Adult, Administration, Intravenous
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