[Modern management of vasovagal syncope]

The management of vasovagal syncope is limited in the majority of cases to reassuring, explaining and advising how to perform some simple methods whose efficacy is assured. When repeated episodes of syncope significantly alter the quality of life, which is the case in about 1% of patients, the management requires medications which are proposed on the basis of as yet uncertain pathophysiological data (beta-blockers, alpha-stimulants, serotonin re-uptake inhibitors), or non-drug treatment (orthostatic training, cardiac pacing). However, none of these treatments has been proved in a randomised study. In these severe and disabling forms, the doctor has to make a choice between empirical prescibing, preferably midodrine, and a more rational strategy guided by an intercritical recording obtained with an implanted ECG monitor which allows better selection of patients who might benefit from pacemaker implantation.