{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:11:54Z","timestamp":1792671114218,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postural orthostatic tachycardia syndrome (POTS) is characterized by symptoms of orthostatic intolerance and is frequently observed in post\u2010COVID conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We conducted controlled, prospective, and randomized clinical trials to explore the potential therapeutic benefits of low\u2010level tragus stimulation (LL\u2010TS) in patients with POTS following COVID\u201019 infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study enrolled 57 participants with confirmed post\u2010acute COVID\u201019 who had been diagnosed with POTS. The ear clip was attached to the right tragus of the patients for stimulation (20\u2009Hz with a 1\u2010ms duration) or sham stimulation. They were divided into two groups: the sham LL\u2010TS group (sham stimulation, <jats:italic>n<\/jats:italic>\u2009=\u200926) and the LL\u2010TS group (stimulation for 1 month, <jats:italic>n<\/jats:italic>\u2009=\u200931). LL\u2010TS was performed 1\u2009h twice daily for 1 month. Postural tachycardia was evaluated at baseline, 1\u2010month visit, and 1\u2010year visit. Heart rate variability (HRV) and plasma neuropeptide Y (NPY) were evaluated at respective time points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of participants was 31.9\u2009\u00b1\u20097.2 years (61.4% female). LL\u2010TS significantly attenuated the increase in heart rate from supine to a 10\u2010min stand, as well as the average and maximum heart rates after 1 month of treatment. LL\u2010TS also significantly reduced NPY levels. In addition, LL\u2010TS significantly increased the high frequency (HF), but decreased the low frequency (LF) and LF\/HF ratio during the postural test (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). These effects persisted during the 1\u2010year follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LL\u2010TS may be a promising therapeutic approach for attenuating autonomic imbalance in patients with POTS following COVID\u201019 infection.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.70110","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T05:19:01Z","timestamp":1741756741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Tragus Nerve Stimulation Attenuates Postural Orthostatic Tachycardia Syndrome in Post COVID\u201019 Infection"],"prefix":"10.1002","volume":"48","author":[{"given":"Zhuo","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology Renmin Hospital of Wuhan University Wuhan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7932-4950","authenticated-orcid":false,"given":"Tongjian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Diseases Xiangyang Central Hospital, Afliated Hospital of Hubei University of Arts and Science Xiangyang Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-2123","authenticated-orcid":false,"given":"Xuping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Second Xiangya Hospital of Central South University Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Renmin Hospital of Wuhan University Wuhan Hubei 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