Well-Managed Postural Orthostatic Tachycardia Syndrome during Dental Therapy and Analysis of Heart Rate Variability: A Case Report

Abstract

This is the first case report of well-managed postural orthostatic tachycardia syndrome (POTS) intraoperatively monitored by heart rate variability (HRV) analysis in dentistry. POTS-associated autonomic dysfunction is induced by postural changes and easily leads to disturbances in circulatory dynamics; however, most dental practices have not yet realized the importance of managing POTS. We measured autonomic activity in a patient with POTS during dental therapy and assessed the clinical significance of HRV analysis for POTS. The patient was a 40-year-old Japanese male. He was diagnosed with impacted wisdom teeth and was in treatment for bronchial asthma and POTS. A surgical procedure to extract the teeth was safely performed under local anesthesia. During the therapy, he developed neither orthostatic tachycardia nor compensatory hypotension in either the upright or supine position. HRV analysis revealed POTS-associated autonomic dysfunction, that is, autonomic instability during postural change. Thus HRV analysis should become a useful tool for safe and secure dental management of POTS.