Vasovagal syncope in the older patient

Vasovagal syncope (VVS) has been diagnosed with increasing frequency in older patients since the head-up tilt-table test (HUT) was described over 2 decades ago. The incidence and prevalence of VVS in this age group remains unknown. Older individuals are more likely to display a dysautonomic hemodynamic pattern with a predominantly hypotensive response during HUT. The positivity rates to passive and isoprotenerol-provoked HUT are reduced with age, but positivity rates for glyceryl-trinitrate-induced HUT are comparable with younger subjects. Few studies into treatment strategies have included older subjects. This is a review of the existing literature on the epidemiology, clinical characteristics, diagnostic tools, and treatment strategies for VVS in older patients, highlighting important areas for future research.