Grant: Project Grant

Postural Orthostatic Tachycardia Syndrome (POTS) is a common disorder (~1%) that causes severe symptoms during standing. It can occur in patients of either sex, and it can occur across all age groups, but it primarily impacts women of childbearing age. The symptoms associated with POTS can cause a poor quality of life and significantly impair productivity in school and work settings, especially for young women. Abnormal control of heart rate and blood pressure by the nervous system is thought to be responsible. Current treatments are minimally effective and often come with side effects, creating an urgent need for new therapeutic approaches. Auricular Vagal Neuromodulation Therapy (aVNT) is a novel therapy that involves low-level electrical stimulation of the external ear. This technique helps regulate heart rate and blood pressure and reduces heart rate in the upright position. The device is small, wearable, easy to use, applied externally, and free from medication side effects. Small studies have suggested that aVNT may be effective, but it is not clear how best to use this. Some studies have stimulated for only 1h/day, while others have required longer use. It is unclear if neuromodulation fully occurs early (e.g. 1 month) or if prolonged use (e.g. 3 months) derives more benefits. Finally, we don't know if the neuromodulation persists even after discontinuing use of the aVNT. This study aims to determine how the use of the aVNT (dose [hours per day] and duration [months]) affects neuromodulation in POTS patients, and whether ongoing therapy is needed or if intermittent aVNT is adequate. These questions are critical to determine how patients with POTS should most effectively use this novel, non-drug treatment. These answers will also inform future definitive clinical trials of aVNT for symptomatic and quality of life improvement for patients with POTS.