{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:05:56Z","timestamp":1793102756417,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Dysautonomia seems to be important for the pathophysiology of psychosomatic diseases and, more recently, for long COVID. This concept may explain the clinical symptoms and could help open new therapeutic approaches. Methods: We compared our data from an analysis of heart rate variability (HRV) in an active standing test in 28 adolescents who had developed an inappropriate sinus tachycardia (IST, n = 13) or postural orthostatic tachycardia syndrome (POTS, n = 15) after contracting COVID-19 disease and\/or vaccination with 64 adolescents from our database who developed dysautonomia due to psychosomatic diseases prior to the COVID-19 pandemic. We prove the effects of our treatment: omega-3 fatty acid supplementation (O3-FA, n = 18) in addition to propranolol (low dose, up to 20-20-0 mg, n = 32) or ivabradine 5-5-0 mg (n = 17) on heart rate regulation and heart rate variability (HRV). Results: The HRV data were not different between the adolescents with SARS-CoV-2-related disorders and the adolescents with dysautonomia prior to the pandemic. The heart rate increases in children with POTS while standing were significantly lower after low-dose propranolol (27.2 \u00b1 17.4 bpm***), ivabradine (23.6 \u00b1 8.12 bpm*), and O-3-FA (25.6 \u00b1 8.4 bpm*). The heart rate in children with IST while lying\/standing was significantly lower after propranolol (81.6 \u00b1 10.1 bpm**\/101.8 \u00b1 18.8***), ivabradine (84.2 \u00b1 8.4 bpm***\/105.4 \u00b1 14.6**), and O-3-FA (88.6 \u00b1 7.9 bpm*\/112.1\/14.9*). Conclusions: The HRV data of adolescents with dysautonomia after COVID-19 disease\/vaccination are not significantly different from a historical control of adolescents with dysautonomia due to psychosomatic diseases prior to the pandemic. Low-dose propranolol &gt; ivabradine &gt; omega-3 fatty acids significantly decrease elevated heart rates in patients with IST and the heart rate increases in patients with POTS and may be beneficial in these children with dysautonomia.<\/jats:p>","DOI":"10.3390\/children10020316","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T03:01:45Z","timestamp":1675825305000},"page":"316","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Therapeutic Approaches to Dysautonomia in Childhood, with a Special Focus on Long COVID"],"prefix":"10.3390","volume":"10","author":[{"given":"Reiner","family":"Buchhorn","sequence":"first","affiliation":[{"name":"Praxis for Pediatrics, Pediatric Cardiology and Adults with Congenital Heart Diasease, Am Bahnhof 1, 74670 Forchtenberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1136\/archdischild-2012-301863","article-title":"Lost among the trees? The autonomic nervous system and paediatrics","volume":"99","author":"Rees","year":"2014","journal-title":"Arch. Dis. Child."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jadohealth.2022.06.022","article-title":"Child and Adolescent Mental Health During the COVID-19 Pandemic: Results of the Three-Wave Longitudinal COPSY Study","volume":"71","author":"Erhart","year":"2022","journal-title":"J. Adolesc. Health Off. Publ. Soc. Adolesc. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bisaccia, G., Ricci, F., Recce, V., Serio, A., Iannetti, G., Chahal, A.A., and Gallina, S. (2021). Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8110156"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chung, T.H., and Azar, A. (2022). Autonomic Nerve Involvement in Post-Acute Sequelae of SARS-CoV-2 Syndrome (PASC). J. Clin. Med., 12.","DOI":"10.3390\/jcm12010073"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e28289","DOI":"10.1002\/jmv.28289","article-title":"Clinical trials on the pharmacological treatment of long COVID: A systematic review","volume":"95","author":"Chee","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Davis, H.E., McCorkell, L., Vogel, J.M., and Topol, E.J. (2023). Long COVID: Major findings, mechanisms and recommendations. Nat. Rev. Microbiol., 1\u201314.","DOI":"10.1038\/s41579-022-00846-2"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103201","DOI":"10.1016\/j.autrev.2022.103201","article-title":"Severe treatment-refractory antibody positive autoimmune autonomic ganglionopathy after mRNA COVID19 vaccination","volume":"21","author":"Rowe","year":"2022","journal-title":"Autoimmun. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Rubin, R. (2023). Large Cohort Study Finds Possible Association Between Postural Orthostatic Tachycardia Syndrome and COVID-19 Vaccination but Far Stronger Link With SARS-CoV-2 Infection. JAMA.","DOI":"10.1001\/jama.2023.0050"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.hrthm.2015.03.029","article-title":"2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope","volume":"12","author":"Sheldon","year":"2015","journal-title":"Heart Rhythm."},{"key":"ref_10","first-page":"1","article-title":"The postural orthostatic stress syndrome in childhood: HRV analysis and the active standing test","volume":"3","author":"Buchhorn","year":"2020","journal-title":"Prev. Med. Community Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","volume":"93","author":"Malik","year":"1996","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Buchhorn, R., Baumann, C., G\u00fcndogdu, S., Rakowski, U., and Willaschek, C. (2020). Diagnosis and management of an inappropriate sinus tachycardia in adolescence based upon a Holter ECG: A retrospective analysis of 479 patients. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238139"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1038\/s41430-017-0052-3","article-title":"Effect of omega-3 long-chain polyunsaturated fatty acid supplementation on heart rate: A meta-analysis of randomized controlled trials","volume":"72","author":"Hidayat","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"van Campen, C., and Visser, F.C. (2022). Orthostatic Intolerance in Long-Haul COVID after SARS-CoV-2: A Case-Control Comparison with Post-EBV and Insidious-Onset Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Patients. Healthcare, 10.","DOI":"10.3390\/healthcare10102058"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1016\/j.jacc.2022.04.019","article-title":"Inappropriate Sinus Tachycardia: Etiology, Pathophysiology, and Management: JACC Review Topic of the Week","volume":"79","author":"Ahmed","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E378","DOI":"10.1503\/cmaj.211373","article-title":"Diagnosis and management of postural orthostatic tachycardia syndrome","volume":"194","author":"Raj","year":"2022","journal-title":"CMAJ Can. Med. Assoc. J.\/J. L\u2019association Med. Can."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"981532","DOI":"10.3389\/fimmu.2022.981532","article-title":"Dysregulated autoantibodies targeting vaso- and immunoregulatory receptors in Post COVID Syndrome correlate with symptom severity","volume":"13","author":"Sotzny","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Buchhorn, R., Meyer, C., Schulze-Forster, K., Junker, J., and Heidecke, H. (2021). Autoantibody release in children after corona virus mRNA vaccination: A risk factor of multisystem inflammatory syndrome?. Vaccines, 9.","DOI":"10.3390\/vaccines9111353"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1161\/CIRCULATIONAHA.122.059971","article-title":"Detection of G Protein-Coupled Receptor Autoantibodies in Postural Orthostatic Tachycardia Syndrome Using Standard Methodology","volume":"146","author":"Hall","year":"2022","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Buchhorn, R. (2022). Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and\/or Vaccination. Vaccines, 10.","DOI":"10.3390\/vaccines10101686"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ijcard.2018.01.110","article-title":"Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men","volume":"259","author":"Lindgren","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/archinte.1997.00440260085013","article-title":"Unrecognized paroxysmal supraventricular tachycardia. Potential for misdiagnosis as panic disorder","volume":"157","author":"Lessmeier","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1042\/CS20140251","article-title":"Cognitive dysfunction in postural tachycardia syndrome","volume":"128","author":"Arnold","year":"2015","journal-title":"Clin. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103052","DOI":"10.1016\/j.autneu.2022.103052","article-title":"Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies","volume":"244","author":"Knoop","year":"2023","journal-title":"Auton. Neurosci. Basic Clin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1212\/WNL.0b013e318293e310","article-title":"Low-dose propranolol and exercise capacity in postural tachycardia syndrome: A randomized study","volume":"80","author":"Arnold","year":"2013","journal-title":"Neurology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1161\/CIRCULATIONAHA.108.846501","article-title":"Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: Less is more","volume":"120","author":"Raj","year":"2009","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jacc.2012.06.031","article-title":"Clinical efficacy of ivabradine in patients with inappropriate sinus tachycardia: A prospective, randomized, placebo-controlled, double-blind, crossover evaluation","volume":"60","author":"Cappato","year":"2012","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/316\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:27:10Z","timestamp":1760120830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,7]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["children10020316"],"URL":"https:\/\/doi.org\/10.3390\/children10020316","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,7]]}}}