Characterization of Postural Orthostatic Tachycardia Syndrome in Long COVID: Self-reported Data From the LISTEN Study.
Al Mouslmani, Mohammad, Sawano, Mitsuaki, Arun, Adith S et al. · JACC. Advances · 2025 · DOI
Quick Summary
This study looked at people with long COVID who also developed POTS (a condition where the heart rate spikes when standing up). Among nearly 600 long COVID patients, about 29% reported having POTS. People with both conditions reported significantly more symptoms—including dizziness, chest pain, extreme fatigue, difficulty exercising, and brain fog—and experienced worse overall health and quality of life compared to those with long COVID alone.
Why It Matters
POTS appears frequently in long COVID and ME/CFS populations and is associated with substantial clinical burden. Understanding the prevalence, symptom clustering, and disease severity in long COVID-associated POTS helps validate patient experiences, informs clinical recognition, and underscores the need for mechanistic research and targeted interventions for this underrecognized phenotype.
Observed Findings
Approximately 29% (167/578) of long COVID participants reported POTS, with 78% being female and a younger age distribution than non-POTS participants.
Participants with POTS reported significantly higher rates of dizziness, palpitations, chest pain, excessive fatigue, exercise intolerance, heat intolerance, brain fog, and migraine.
POTS-positive participants reported worse overall health status, greater financial difficulties, increased social isolation, and higher rates of suicidal ideation.
Co-occurrence of myalgic encephalomyelitis/chronic fatigue syndrome and mast cell disorders was more common in the POTS group.
Inferred Conclusions
Long COVID-associated POTS represents a clinically significant phenotype with distinct symptom profiles and substantial health burden across physical, cognitive, and psychological domains.
The predominance of female participants and younger age suggest sex and age-dependent susceptibility factors.
The clustering of POTS with systemic symptoms, exercise intolerance, and dysautonomic features suggests shared pathophysiological mechanisms that warrant investigation.
Remaining Questions
What are the mechanistic pathways linking COVID-19 to POTS development, and do they differ from POTS in other post-infectious syndromes?
How do objectively-confirmed POTS cases (via tilt-table or Holter monitoring) differ in prevalence and phenotype from self-reported cases in this cohort?
What This Study Does Not Prove
This study does not establish whether POTS causes the observed symptoms, whether COVID directly triggered POTS development, or whether the findings generalize beyond online-survey participants. Self-reported diagnosis is not confirmed by objective testing (tilt-table testing, continuous heart rate monitoring), so actual POTS prevalence may differ from the reported 28.9%. Cross-sectional data cannot prove temporal relationships or mechanism.