Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome.

Coffin ST, Black BK, Biaggioni I, Paranjape SY, Orozco C, Black PW, Dupont WD, Robertson D, Raj SR
Heart Rhythm. 2012 9 (9): 1484-90

PMID: 22561596 · PMCID: PMC3419341 · DOI:10.1016/j.hrthm.2012.05.002

BACKGROUND - Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing, and many patients with POTS have low blood volume. Increasing blood volume is a promising approach to this problem.

OBJECTIVE - To test the hypothesis that desmopressin (DDAVP) will attenuate the tachycardia and improve symptom burden in patients with POTS.

METHODS - In this protocol, patients with POTS (n = 30) underwent acute drug trials with DDAVP 0.2 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while seated and after standing for up to 10 minutes prior to and hourly for 4 hours following study drug.

RESULTS - The standing heart rate was significantly lower following DDAVP than placebo (101.9 ± 14.5 beats/min vs 109.2 ± 17.4 beats/min; P <.001). Standing blood pressure was not affected (P = .28). The symptom burden improved with DDAVP (from a score of 18 ± 18 arbitrary units [AU] to 13 ± 15 AU at 2 hours) compared with placebo (from 18 ± 17 AU to 19 ± 16 AU; P = .010).

CONCLUSIONS - Oral DDAVP significantly attenuated tachycardia and improved symptoms in POTS. The safety profile of this approach would need to be examined before it can be recommended for routine treatment of these patients.

Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

MeSH Terms (15)

Adult Analysis of Variance Antidiuretic Agents Autonomic Nervous System Blood Pressure Deamino Arginine Vasopressin Female Health Status Indicators Heart Rate Hemostatics Humans Male Pilot Projects Postural Orthostatic Tachycardia Syndrome Single-Blind Method

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