Conservative treatment

Encourage fluid & salt intake

Physical counterpress maneuver

•Isometric exercise of large muscles (39% risk reduction)

Tilt training

•Limited research findings

Medications

•Beta blockers

•Fludrocortisone

•Midodrine

•Serotonin transporter inhibitors

Invasive treatment

Device therapy

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Class IIa

•Pts >40yrs with recurrent unpredictable syncope with documented >3s symptomatic pause or >6s asymp pause (B)

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Class IIb

•Paed pts with recurrent syncope with documented asystole who are refractory to medical therapy (B)

•Adenosine-susceptible older pts who have unexplained syncope without a prodrome, normal ECG and no SHD (C)