Unraveling POTS: A Dialog With Dr. Stavros Stavrakis


In a latest article, we highlighted a brand new remedy for individuals affected by postural tachycardia syndrome (POTS). Oklahoma medics counsel utilizing a pocket sized transportable neuromodulation system to alleviate the troublesome signs related to POTS. 

Primarily, POTS sufferers have bother regulating coronary heart fee (it will increase when standing up), blood stress, respiration, and so they have elevated adrenaline* ranges. Transcutaneous electrical stimulation of the vagus nerve utilizing a TENS machine can stimulate the vagus nerve from the tragus to affect these physique capabilities.

The system delivers focused micropulses {of electrical} present to modulate the nervous system. The vagus nerve runs from the mind, via the center and lungs, to the intestines and oversees coronary heart fee, constriction of blood vessels, digestion, respiration, and immune functioning. Stimulating this nerve might help to scale back signs of dizziness, fainting, and fatigue. 

We had the chance to talk to Dr. Stavros Stavrakis, a clinician scientist investigating new remedies for POTS.

Stavros Stavrakis, M.D., Ph.D. is a scientific cardiac electrophysiologist and Affiliate Professor of Medication on the College of Oklahoma Well being Sciences Middle.

His most important space of focus is in cardiology: atrial fibrillation, arrhythmias, and POTS.

Medical Information Bulletin: How did the concept for the system come about, and is it the primary of its variety?

Dr. Stavrakis: The concept of utilizing tragus stimulation is ours, however the system has already been on the market. We used a commercially out there system [the ParasymTM  TENS machine]. It’s not out there within the US but, it’s solely out there in Europe for now. We beforehand seen plenty of helpful results of the system on the center: suppression of irritation, lower in arrhythmias, and on coronary heart construction and performance. Placing all the things collectively, POTS is a syndrome, which means it has plenty of manifestations. We hypothesized that utilizing this system would lower the rise in coronary heart fee that occurs with standing. It’s an anti-adrenergic intervention, and a rise in adrenaline is what drives it. We first examined it in animals and confirmed that it was doable to lower the rise in coronary heart fee and reduce irritation as properly. Then we proceeded to check it in human trials.

Medical Information Bulletin: What do your research outcomes counsel concerning the underlying causes of POTS?

Dr. Stavrakis: It helps the concept POTS is multifactorial, and a rise in adrenaline performs a central function. There may be nonetheless extra to know concerning the pathophysiology. Discovering that antibodies decreased publish system stimulation was an important part. Whether or not this system is therapeutic or not, we don’t know but. We are actually phenotyping sufferers for bigger subgroups. 

Medical Information Bulletin: Is there anybody that shouldn’t use this system, for instance individuals with pacemakers?

Dr. Stavrakis: No. The output of the system could be very small, and it really helps individuals with atrial fibrillation. In actual fact, we performed a earlier research on this, revealed in 2020 known as “TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Medical Trial.”

Medical Information Bulletin: What’s the longevity of the system?

Dr. Stavrakis: Not less than 6 months to a yr. There’s a sustained impact after stopping the stimulation, based mostly on prior research. You don’t want to make use of it on a regular basis. However this wants testing to verify.

Medical Information Bulletin: What are the subsequent steps for you and your group, following the findings of this research?

Dr. Stavrakis: To have the ability to personalize this remedy, and to have the ability to choose which affected person would profit most from utilizing this system.

Medical Information Bulletin: How widespread do you envision the system for use for most of the people?

Dr. Stavrakis: If we’re capable of finding the suitable sufferers to prescribe the system, then will probably be the principle remedy.

Medical Information Bulletin: With the rise of synthetic intelligence and machine studying, do you foresee these applied sciences enjoying a task in predicting which sufferers may reply greatest to remedies like noninvasive vagus nerve stimulation? How might it assist with future iterations of this system?

Dr. Stavrakis: I envision an earpod that might measure some form of physiological biomarker and implement remedy when wanted. The biomarker would then run underneath an AI algorithm to present the wanted knowledge. I see this occurring with a 5-10 yr time horizon. 

Our honest thanks to Dr. Stavrakis for his kindness and generosity along with his time.


* Adrenaline, often known as epinephrine, is a hormone made and despatched via the bloodstream by the adrenal glands throughout instances of stress or hazard. That is a part of the “fight-or-flight” response. 

The tragus is a small, pointed piece of cartilage situated on the outer a part of the ear. It tasks backward, partially overlaying the opening of the ear canal.

‡ An anti-adrenergic intervention works to dam the impact of neurotransmitters (epinephrine (adrenaline), norepinephrine (noradrenaline), or dopamine) and cut back irregular stimulation that results in an abnormally quick heartbeat, overly forceful heartbeats, and hypertension.


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