[Vasovagal syncope, from diagnosis to treatment]

The concept of vasovagal syncope has changed over the last 10 years. The clinical presentation has changed since the observation of syncopes of vasovagal origin resembling the sudden syncope of the Stokes-Adams syndrome. The physiopathology has been considerably improved but none of the hypotheses proposed is universally accepted. The results of research already performed and of that underway, prompted by these hypotheses, will be determinant for the elucidation of the relations of the cardiovascular and autonomic nervous systems. This revolution is largely due to the introduction of the tilt test in the 1980s as a clinical means of investigation of the autonomic nervous system. Its protocol and results remain to be confirmed but it has already become a reference examination with the same value as Holter monitoring and electrophysiological studies in the evaluation of unexplained syncope after classical investigations. Therapy has improved after these diagnostic improvements and recent physiopathological hypotheses; their number and absence of strictly performed controlled studies are only reflections of this rapidly evolving subject. Only time and randomised trials, with double-blind protocols when possible, will enable effective treatment and a greater precision in the clinical indications.