17 Feb Postural Orthostatic Tachycardia Syndrome in COVID Long-Haulers May be Helped by Ivabradine

MedicalResearch.com Interview with:

Dr. Taub

Pam R. Taub, MD, FACC, FASPC
Director of  Step Family Foundation Cardiovascular Rehabilitation and Wellness Center
Associate Professor of Medicine
UC San Diego Health System
Division of Cardiovascular Medicine

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by postural orthostatic tachycardia syndrome?  Is it more common in patients who have incompletely recovered from a COVID-19 infection? 

Response: Postural Orthostatic Tachycardia Syndrome (POTS) is a, complex multisystem clinical syndrome Patients experience a wide spectrum of symptoms of varying severity, which are often debilitating.  Upon assuming an upright standing position from being supine, patients experience an increase in heart rate by 30 beats per minute (bpm) from supine position, This is often accompanied by lightheadedness, palpitations, dyspnea, mental clouding (“brain fog”), headaches.

POTS can occur after infections as it thought to be triggered by the immune system .  The hypothesis is that when the body is fighting an infection some of the antibodies it produces can attack our regulatory systems that control heart rate and blood pressure.

We are seeing an increase in POTS cases occurring after COVID-19 infection.  These patient are referred to as the “long haulers”

These long haulers have elevated heart rate, fatigue, brain fog and shortness of breath with activity consistent with POTS.

We are seeing that  COVID-19 is another infection that can lead to POTS.

Some articles on this

https://www.thedenverchannel.com/news/national/coronavirus/some-covid-19-survivors-being-diagnosed-with-syndrome-called-pots

MedicalResearch.com: What are the main findings? 

Response: Postural Orthostatic Tachycardia Syndrome significantly impairs quality of life for patients as they are not able to do activities that involve standing up. This study shows that ivabradine (which selectively and specifically inhibits the SA node, which directly decreases HR without lowering BP) provides significant improvements in in heart rate and quality of life.

By decreasing the heart rate and allowing patients to stand up they can then engage in activities such as exercise that prevents deconditioning.

MedicalResearch.com: What should readers take away from your report? 

Response: Ivabradine has a novel mechanism of action that can be useful for patients with Postural Orthostatic Tachycardia Syndrome.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Would like to see a study specifically looking at post-COVID POTS.

Any disclosures?   A grant from Amgen was received to conduct this investigator initiated clinical trial

Citation:

Randomized Trial of Ivabradine in Patients With Hyperadrenergic Postural Orthostatic Tachycardia Syndrome Pam R. Taub, MD,a, * Adena Zadourian, BS,a, * Hannah C. Lo, BS,a Cameron K. Ormiston, BS,a Shahrokh Golshan, PHD,b Jonathan C. Hsu, MD, MASa

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 77, NO. 7, 2021 ª 2021

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Last Updated on February 17, 2021 by Marie Benz MD FAAD