Community-Based Trial of Compression Tights in POTS

Dec 02, 2024
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Authors:
Bourne KM, Karalasingham K, Siddiqui T, et al.
Citation:
A Community-Based Trial of Commercially Available Compression Tights in Patients With Postural Orthostatic Tachycardia Syndrome. JACC Clin Electrophysiol 2024;Nov 27:[Epublished].
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Commercially available waist-high compression (WHC) tights are an effective treatment for patients with postural orthostatic tachycardia syndrome (POTS) in a community setting.
  • Furthermore, the WHC garment reduced upright heart rate and improved symptoms acutely, and these effects were sustained after several hours of use.
  • These benefits were present even when participants were taking heart rate–reducing medications, reflecting the multipronged management approach for POTS.

Study Questions:

What is the ability of commercially available waist-high compression (WHC) garments to reduce heart rate and improve symptoms in patients with postural orthostatic tachycardia syndrome (POTS) in a community setting?

Methods:

The investigators conducted a study, which involved the before–after comparison without medication, although the order of the two study days was crossed over when both protocols were performed. The study was conducted in a virtual community setting with no in-person laboratory participation. Participants (n = 26) held medications during protocol #1 and took medications as normal during protocol #2. For each, participants completed four, 10-minute active stand tests in the morning (AM) and afternoon (PM) with the garments on (ON) and off (OFF) (AM-OFF, AM-ON, PM-ON, and PM-OFF). Heart rate (Holter monitor) and symptoms (Vanderbilt Orthostatic Symptom Score [VOSS]) were measured for each standing test. Two-factor repeated measures analysis of variance tests were used to compare compression (on/off) and time during each minute of standing for AM-OFF versus AM-ON and PM-OFF versus PM-ON.

Results:

Protocol #1: Standing heart rate was reduced (105 [99-116] bpm vs. 119 [105-130] bpm; p < 0.001) and symptoms improved (p < 0.001), during AM-ON versus AM-OFF. Standing heart rate (p = 0.04) and symptoms (p = 0.004) increased when compression was removed after several hours. Protocol #2: Standing heart rate was reduced (84 [77-90] bpm vs. 89 [84-100] bpm; p < 0.001), and symptoms improved (p = 0.03), during AM-ON versus AM-OFF. Standing heart rate (p = 0.02) and symptoms (p < 0.001) increased when compression was removed after several hours.

Conclusions:

The authors report that commercially available compression tights reduced heart rate and symptoms both acutely and after several hours of use.

Perspective:

This study reports that commercially available WHC tights are an effective treatment for patients with POTS in a community setting. Furthermore, the WHC garment reduced upright heart rate and improved symptoms acutely, and these effects were sustained after several hours of use. These benefits were present even when participants were taking heart rate–reducing medications, reflecting the multipronged management approach for POTS. Additional studies are indicated to assess longer-term (weeks to months) benefits from compression garments in patients with POTS.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Postural Orthostatic Tachycardia Syndrome, Stockings, Compression


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