Vagus Nerve Stimulation (VNS) and POTS: A New Way to Manage Symptoms?

Postural Orthostatic Tachycardia Syndrome (POTS) can be a challenging condition to live with. Rapid heart rate (tachycardia), dizziness, and sometimes even fainting (syncope) are just a few of the symptoms that disrupt daily life. At its core, POTS is a form of dysautonomia, meaning the autonomic nervous system (which controls things like heart rate, blood pressure, and digestion) isn’t working as it should.

One potential approach to managing POTS is vagus nerve stimulation (VNS). The vagus nerve plays a key role in calming the body and maintaining a balance between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) systems. For people with POTS, where this balance is often off, VNS might offer a new way to regulate symptoms.

The vagus nerve is responsible for many of the body’s essential functions. It slows the heart, regulates blood pressure, supports digestion (neuro gastroenterology), and even impacts stress responses through cortisol regulation.

In POTS, the sympathetic system tends to dominate (sympathetic overdrive), leading to a fast heart rate, unstable blood pressure, and other symptoms. Low vagal tone—when the vagus nerve isn’t functioning optimally—might make it harder for the body to counteract this overactivity. By stimulating the vagus nerve, VNS aims to restore this balance, improving parasympathetic activity and calming the overactive systems.

Here are some of the ways VNS might help manage POTS symptoms:

One of the hallmark symptoms of POTS is a significant increase in heart rate when standing. VNS could help reduce tachycardia by enhancing parasympathetic activity, slowing the heart down.

Blood pressure regulation can be erratic in POTS, contributing to dizziness and fainting (vasovagal response issues). By improving communication between the brain and cardiovascular system, VNS might help stabilize blood flow and reduce these symptoms.

Many people with POTS experience nausea, bloating, or other digestive issues. Since the vagus nerve is a key player in the gut-brain connection, VNS might help ease these neuro gastroenterology problems.

POTS can leave the body in a constant state of stress. VNS has been shown to reduce cortisol levels and inflammation, both of which might improve overall symptom management.

Sleep disruptions are common in POTS. VNS could help regulate the sleep-wake cycle, improving rest and recovery, which are essential for managing symptoms.

VNS doesn’t just target symptoms—it may also support the nervous system’s overall health. For example:

• It increases BDNF (Brain-Derived Neurotrophic Factor), which is important for synaptic plasticity and nervous system adaptability.
• It may reduce nerve-related issues like peripheral neuropathy by improving myelination.
• It modulates cortical excitability, which could help stabilize the nervous system under stress.

These broader effects suggest that VNS might not only manage symptoms but also support longer-term improvements in autonomic function.

While VNS offers exciting possibilities, it’s not a standalone solution for POTS. It works best as part of a broader management plan, which might include hydration, salt intake, light exercise, and other lifestyle adjustments. If you’re considering VNS, it’s essential to work with a healthcare provider who specializes in autonomic disorders to determine if it’s right for you.

POTS is a complex condition, but new tools like VNS devices such as Vagustim are providing hope for better symptom management and improved quality of life. With ongoing research, we’re learning more about how to tackle this condition from multiple angles.

Keywords: Dysautonomia, Tachycardia, Syncope, Sympathetic overdrive, Vasovagal response, Blood pressure, Cortisol regulation, Neurogastroenterology, Sleep-wake cycle, Brain-Derived Neurotrophic Factor (BDNF), Synaptic plasticity, Peripheral neuropathy, Myelination, Cortical excitability

1. Stavrakis, S., Chakraborty, P., Farhat, K., Whyte, S., Morris, L., Asad, Z. U. A., Karfonta, B., Anjum, J., Matlock, H. G., Cai, X., & Yu, X. (2023). Noninvasive vagus nerve stimulation in postural tachycardia syndrome. JACC. Clinical Electrophysiology, 10(2), 346–355. https://doi.org/10.1016/j.jacep.2023.10.015

2. Deng, J., Li, H., Guo, Y., Zhang, G., Fischer, H., Stavrakis, S., & Yu, X. (2022). Transcutaneous vagus nerve stimulation attenuates autoantibody-mediated cardiovagal dysfunction and inflammation in a rabbit model of postural tachycardia syndrome. Journal of Interventional Cardiac Electrophysiology, 66(2), 291–300. https://doi.org/10.1007/s10840-022-01144-w