For the current analysis, we investigated the effect of a new therapy with low-dose propranolol and ivabradine in children with POTS or IST in the active standing test: propranolol: 10-10-0, up to 20-20-0 mg (n = 32), ivabradine: 5-5-0 mg (n = 18). This therapy was based upon a consensus statement of the Heart Rhythm Society published in 2015 [9 (link)].
We further investigated the impact of omega-3 fatty acid supplementation (O3-FA, n = 18) on heart rate in the active standing test. As recently published, we introduced O3-FA supplementation in children with inappropriate sinus tachycardia [12 (link)] after showing a significant reduction in the mean heart rate in 24 h ECGs in accordance with a recent meta-analysis [13 (link)]. Patients usually purchased products based upon 1–2 g fish oil per day rate from a retail store. The adolescents received at least 800 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day.
In the first visit, children with dysautonomia were provided lifestyle advice, including increased fluid and salt intake, low-dose exercise, and omega-3 fatty acid supplementation. If these lifestyle interventions were not successful, we introduced pharmacotherapy, first with low-dose propranolol and second with ivabradine if the propranolol did not improve the clinical symptoms. Omega-3 fatty acid supplementation was not stopped during pharmacotherapy.
We further investigated the impact of omega-3 fatty acid supplementation (O3-FA, n = 18) on heart rate in the active standing test. As recently published, we introduced O3-FA supplementation in children with inappropriate sinus tachycardia [12 (link)] after showing a significant reduction in the mean heart rate in 24 h ECGs in accordance with a recent meta-analysis [13 (link)]. Patients usually purchased products based upon 1–2 g fish oil per day rate from a retail store. The adolescents received at least 800 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day.
In the first visit, children with dysautonomia were provided lifestyle advice, including increased fluid and salt intake, low-dose exercise, and omega-3 fatty acid supplementation. If these lifestyle interventions were not successful, we introduced pharmacotherapy, first with low-dose propranolol and second with ivabradine if the propranolol did not improve the clinical symptoms. Omega-3 fatty acid supplementation was not stopped during pharmacotherapy.
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