Preexisting conditions seen in all patients with tachycardia after COVID-19 vaccine

Patients with post-COVID-19 vaccination postural orthostatic tachycardia syndrome (POTS) all have preexisting conditions, according to a study published in the January issue of Heart Rhythm.

Debbie Lin Teodorescu, M.D., from the Cedars-Sinai Medical Center in Los Angeles, and colleagues prospectively collected data from 10 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 between the patients and 24 healthy controls.

Conditions that could increase the risk for POTS were seen in all patients, including previous COVID-19 infection, hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, and autoimmune, cardiac, neurological, or gastrointestinal conditions. The researchers found that compared with controls, a lower ambulatory root mean square of successive differences was seen in HRV for patients (46.19 ± 24 versus 72.49 ± 40.8 ms).

Reduced mean amplitude was seen in SKNA for patients versus controls (0.97 ± 0.052 versus 1.2 ± 0.31 µV); burst amplitude was also reduced (1.67 ± 0.16 versus 4.3 ± 4.3 µV). All patients reported improvement with the usual POTS care after 417.2 ± 131.4 days of follow-up; relapses of POTS symptoms were reported in two with COVID-19 reinfection and one with small fiber neuropathy.

"These findings suggest it may be helpful to keep an eye on patients with underlying health issues after COVID-19 vaccination to monitor for postvaccine POTS," coauthor Peng-Sheng Chen, M.D., also from the Cedars Sinai Medical Center, said in a statement.

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