Postural orthostatic tachycardia syndrome after COVID-19 vaccination: A systematic review.

Publication date: Nov 13, 2024

The global COVID-19 vaccination campaign, with 13. 53 billion doses administered by early 2024, has significantly reduced severe illness and mortality. However, potential adverse effects, such as Postural Orthostatic Tachycardia Syndrome (POTS), have raised concerns. This systematic review evaluates the incidence, mechanisms, and clinical implications of POTS following COVID-19 vaccination. A systematic search of PubMed, EMBASE, and Web of Science was conducted up to June 7, 2024, following PRISMA guidelines to identify studies related to COVID-19 vaccines and POTS. Eligible studies included randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports. Screening, data extraction, and quality assessment were independently performed by two reviewers using the Joanna Briggs Institute Checklists and the Newcastle-Ottawa Scale. Of the 1,531 articles identified, 10 met the inclusion criteria, encompassing a total of 284,678 participants. These studies included five case reports, two case series, one cross-sectional study, one prospective observational study, and one cohort study. The cohort study reported that the odds of new POTS diagnoses post-vaccination were 1. 33 (95% CI: 1. 25-1. 41) compared to the 90 days prior. In contrast, the post-infection odds were 2. 11 (95% CI: 1. 70-2. 63), and the risk of POTS was 5. 35 times higher (95% CI: 5. 05-5. 68) post-infection compared to post-vaccination. Diagnostic findings across studies included elevated norepinephrine levels and reduced heart rate variability. Reported management strategies involved ivabradine, intravenous therapies, and lifestyle modifications. The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. Further research is needed to clarify the incidence, mechanisms, and long-term outcomes of vaccine-related POTS to inform effective clinical management strategies.

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Concepts Keywords
Illness Autonomic disorders
June COVID-19 vaccination
Ottawa POTS
Vaccination SARS-CoV-2 infection
Systematic review
Vaccine adverse effects

Semantics

Type Source Name
disease MESH Postural orthostatic tachycardia syndrome
disease MESH COVID-19
disease IDO quality
drug DRUGBANK Methionine
disease MESH infection
drug DRUGBANK Norepinephrine
drug DRUGBANK Ivabradine
disease MESH lifestyle
pathway REACTOME SARS-CoV-2 Infection
disease MESH Long Covid
pathway REACTOME Reproduction
drug DRUGBANK Aspartame
drug DRUGBANK Coenzyme M
disease MESH Tachycardia
disease MESH dysautonomia
disease MESH syncope
disease IDO blood
disease MESH viral infections
disease MESH autoimmune responses
disease MESH etiology
disease IDO process
disease MESH Orthostatic Intolerance
disease IDO country
disease IDO symptom
drug DRUGBANK Indoleacetic acid
disease MESH relapses
disease MESH reinfection
drug DRUGBANK Trestolone
drug DRUGBANK Pregabalin
drug DRUGBANK Ramelteon
drug DRUGBANK Immune Globulin Human
disease MESH myocarditis
drug DRUGBANK Propranolol
drug DRUGBANK Droxidopa
drug DRUGBANK Fludrocortisone
disease MESH sinus tachycardia
disease MESH hypertension
drug DRUGBANK Prednisone
drug DRUGBANK Water
disease MESH hypokalemia
disease MESH neuropathic pain
drug DRUGBANK Midodrine
drug DRUGBANK Clonidine
drug DRUGBANK Pyridostigmine
drug DRUGBANK Oxygen
disease MESH hypovolemic
pathway REACTOME Muscle contraction
disease MESH small fiber neuropathy
disease MESH syndrome
disease MESH inflammation
disease IDO history
disease IDO intervention
disease IDO role
disease MESH confusion
disease MESH breast cancer
pathway KEGG Breast cancer
drug DRUGBANK Cetuximab
disease MESH neck cancer
disease MESH orthostatic hypotension
disease MESH hypotension
disease MESH heart failure
disease MESH Parkinson’s Disease
disease MESH venous insufficiency
disease MESH Chronic fatigue syndrome

Original Article

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