Sotalol: A new alternative in medically-resistant pediatric POTS-a case series

Postural orthostatic tachycardia syndrome (POTS) causes an increase in heart rate of >40 beats per minute with positional change. We describe 3 interesting cases of “treatment-resistant” pediatric POTS patients with profound symptoms managed with sotalol. Treatment led to heart rate control and symptom improvement with no signs of toxicity. • Viral triggers for development of treatment-resistant POTS in previously well-controlled patients • Successful use of sotalol with clinical improvement and without signs of toxicity • Proposed pathophysiology for treatment-resistant POTS