Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome.

Background: Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance associated with a significant symptom burden. Compression garments are a frequently prescribed treatment, but the effectiveness of waist-high compression has not been evaluated in adults with POTS.
Objectives: This study evaluated compression garments as a treatment for POTS using a head-up tilt test (HUT), and a noninflatable core and lower body compression garment.
Methods: Thirty participants completed 10-min HUT with each of 4 compression conditions in a randomized crossover design. The conditions were no compression (NONE), lower leg compression (LEG), abdominal/thigh compression (ABDO), and full abdominal/leg compression (FULL). Heart rate, beat-to-beat blood pressure, and Vanderbilt Orthostatic Symptom Score ratings were measured during each HUT.
Results: The compression garment reduced heart rate (NONE: 109 ± 19 beats/min; LEG: 103 ± 16 beats/min; ABDO: 97 ± 15 beats/min; FULL: 92 ± 14 beats/min; p < 0.001) and improved symptoms (p < 0.001) during HUT in a dose-dependent manner. During HUT, stroke volume and systolic blood pressure were better maintained with FULL and ABDO compression compared with LEG and NONE compression.
Conclusions: Abdominal and lower body compression reduced heart rate and improved symptoms during HUT in adult patients with POTS. These effects were driven by improved stroke volume with compression. Abdominal compression alone might also provide a clinical benefit if full lower body compression is not well tolerated. (Hemodynamic Effects of Compression in POTS; NCT03484273).
Competing Interests: Author Disclosures This study was supported by funding from the Libin Cardiovascular Institute. Ms. Kate Bourne is a Vanier Scholar supported by the Canadian Institutes of Health Research. Dr. Sheldon has been a network investigator for the Cardiac Arrhythmia Network of Canada. Dr. Exner has been a network investigator for the Cardiac Arrhythmia Network of Canada. Dr. Raj has been a consultant for Lundbeck NA Ltd. and Theravance Biopharma; has been the Chair of the Data Safety and Monitoring Board for Arena Pharmaceuticals; has been a network investigator for Cardiac Arrhythmia Network of Canada; and has been a member of the Medical Advisory Board of Dysautonomia International and PoTS UK, both without financial compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)