Pathophysiology of Reflex Syncope: A Review

Wayne O. Adkisson MD; David G. Benditt MD


J Cardiovasc Electrophysiol. 2017;28(9):1088-1097. 

In This Article


Reflex syncope is the most common form of syncope and within the category of reflex syncope, VVS is by far the most common in all age groups. While much is known regarding the function of the baroreceptor reflex and control of CBF, there is much we do not understand regarding how autonomic control fails transiently and syncope results. The latter is especially true of the rare types of situational syncope.

Treatment is aimed at the avoidance of triggers when possible, or suppression of triggers, such as coughing. Permanent pacing is generally recommended in CSS with asystole >3 seconds (although 6 seconds may be a better criterion). Pacing therapy in VVS needs additional clarification. The use of permanent pacing for the various situational syncope syndromes is unlikely to ever have a definitive trial, given the rarity of the individual conditions. In these latter patients, one has no recourse other than deciding with the patient what, for that patient, seems to be the most reasonable course of therapy.