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Syncope and POTS – time for a multidisciplinary unit?

Dr Nick Gall (King’s College Hospital, London) highlighted the importance of a multidisciplinary approach in managing patients with postural orthostatic tachycardia syndrome (POTS). Patients often have multi-system involvement including: joint hypermobility, chronic fatigue syndrome and physical deconditioning, irritable bowel syndrome, autonomic neuropathy and symptoms of pre-syncope and reflex tachycardia.

The importance of a good bedside approach was highlighted by Dr Jane Hutton (South London and Maudsley NHS Foundation Trust, London), especially when managing a patient with anxiety or low mood – all too common unfortunately in patients with POTS. Professor Rose Anne Kenny (Trinity College, Dublin, Ireland) presented the findings of the European Heart Rhythm Association (EHRA) Consensus document on the rationale and requirement for a Syncope Unit to manage these patients. In particular, the need for specialists in cardiology, neurology, internal medicine, geriatrics and psychology to collaborate together was emphasised.

Finally, an interesting discussion followed regarding the benefits of cognitive behavioural therapy (CBT) for the management of pseudosyncope. Issues that may be addressed by CBT include identification of unhelpful thought patterns, adjusting to unpredictability, improving sleep patterns and enhancing self-esteem. Although evidence for CBT in pseudosyncope is limited, one randomised trial demonstrated greater seizure free events at the end of treatment vs. standard treatment. This difference was not maintained at follow-up, however. The speakers discussed sustaining improvement through relapse prevention programmes including mindfulness-based cognitive behavioural therapy (MBCBT) and medication strategies.

Published on: November 8, 2016

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