Holter-Based Heart Rate Variability Distinguishes Adolescent Postural Orthostatic Tachycardia Syndrome from Healthy...

Area of Science:

• Cardiology
• Autonomic Neuroscience
• Pediatric Health

Background:

• Postural Orthostatic Tachycardia Syndrome (POTS) involves autonomic dysregulation.
• Ambulatory markers for autonomic phenotyping in POTS are not fully defined.

Purpose of the Study:

• Compare Holter-derived heart rate variability (HRV) metrics between adolescents with POTS and healthy controls.
• Identify candidate discriminatory thresholds for POTS using HRV.

Main Methods:

• Retrospective case-control analysis of Holter data (19 POTS patients, 44 controls).
• Analysis of HRV metrics using Kubios HRV Premium software.
• Statistical comparisons included Welch's t-test, Benjamini-Hochberg adjustment, and ROC analysis.

Main Results:

• POTS patients exhibited lower time- and frequency-domain HRV compared to controls.
• POTS group showed higher sympathetic indices (SNSi) and lower parasympathetic indices (PNSi).
• PNSi was the strongest discriminator (AUROC 0.874), with a threshold of ≤ -1.10.

Conclusions:

• Holter-derived HRV metrics reveal reduced parasympathetic modulation and relative sympathetic predominance in adolescent POTS.
• Candidate discriminatory thresholds for HRV metrics may aid in POTS phenotyping.
• Further validation in independent cohorts is warranted.