Outcomes of Fast-track Outpatient Clinic for Rhythm and Conduction Disorders: Focus on Postural Tachycardia Syndrome and Literature Review

Abstract

Aims: To highlight the outcomes of nurse-led fast-track outpatient clinic for rhythm and conduction disturbances yielding patients with postural tachycardia syndrome. Patients and Methods: In the setting of fast-track nurse-led outpatient clinic for rhythm and conduction disturbances of 483 Caucasian subjects who were evaluated for palpitation, presyncope and syncope, fatigue and dyspnea between May 2014 and August 2016. Analysis for exclusion of any cardiac cause included medical history, physical examination, resting ECG, laboratory testing, Holter recording, exercise tolerance testing (ETT), echocardiography (TTE), and when postural tachycardia syndrome (PoTS) was suspected a head-up tilt test (HUT) was performed. During HUT, electrocardiogram, encephalogram, blood pressure was recorded. Results: Focused on patients with PoTS, among 47 (46 F and 1 M) subjects who underwent HUT, ten patients (mean age 42.1, range 22-62 years) had PoTS. Patients had a cluster of symptoms and presented with a history of presyncope and syncope (n = 7), fatigue (n = 5), mood change (n = 5), palpitation (n = 5), nausea (n = 4) and exercise intolerance (n = 3). Resting recumbent ECG depicted regular sinus rhythm in all. Echocardiography findings were normal. ETT was normal in 9 and inconclusive in one. Holter recording revealed normal rhythm variation and sinus tachycardia (n= 8). PoTS was confirmed during HUT test in all 10 subjects. Different non-pharmacological measures and trials of pharmacological regimens were initiated. Conclusions: Fast-track outpatient clinics for rhythm and conduction disturbances may lead to earlier recognition of PoTS. When PoTS is timely diagnosed, tailored management may be established.