Review Article

Non-invasive Vagus Nerve Simulation in Postural Orthostatic Tachycardia Syndrome

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Postural orthostatic tachycardia syndrome (POTS) is a chronic debilitating condition of orthostatic intolerance, predominantly affecting young females. Other than postural tachycardia, symptoms of POTS include a spectrum of non-cardiac, systemic and neuropsychiatric features. Despite the availability of widespread pharmacological and non-pharmacological therapeutic options, the management of POTS remains challenging. Exaggerated parasympathetic withdrawal and sympathetic overdrive during postural stress are principal mechanisms of postural tachycardia in POTS. Non-invasive, transcutaneous, vagus nerve stimulation (tVNS) is known to restore sympathovagal balance and is emerging as a novel therapeutic strategy in cardiovascular conditions including arrhythmias and heart failure. Furthermore, tVNS also exerts immunomodulatory and anti-inflammatory effects. This review explores the effects of tVNS on the pathophysiology of POTS and its potential as an alternative nonpharmacological option in this condition.

Disclosure:The authors have no conflicts of interest to declare.



Published online:


NIH/NHLBI R01HL161008 to SS. PC is supported by the George Mines Travelling Fellowship from the Canadian Heart Rhythm Society.

Correspondence Details:Stavros Stavrakis, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK 73104, US. E:

Open Access:

This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

Figure 1: Mechanisms of Postural Tachycardia in POTS

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Figure 2: Postural Haemodynamics

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Figure 3: G Protein Receptor-coupled Functional Autoantibodies in POTS

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Figure 4: Mechanisms of Action of Transcutaneous Vagus Nerve Stimulation

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Figure 5: Mechanisms of Symptom Improvement with tVNS in POTS

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