Inclusion criteria | Exclusion criteria |
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Patients affected by clinical diagnosis of reflex syncope who meet all the following criteria: 1- Age ≥40 years 2- Significant limitation of social and working life due to unpredictable frequent syncopal recurrences (≥2 within the last year) 3- Type 2B cardio-inhibitory response to the TT (according to the VASIS classification) 4- Alternative therapies have failed or were not feasible 5- Exclusion of other possible competitive causes of syncope | 1- Any other indication to pacemaker, implantable defibrillator or cardiac resynchronization therapy, according to current guidelines 2- Any cardiac dysfunctions possibly leading to loss of consciousness: Overt heart failure Left ventricular ejection fraction (LVEF) <40% (echo-assessed within 3 months prior to study participation) Myocardial infarction Diagnosis of hypertrophic or dilated cardiomyopathy Clinically significant valvular disease Sinus bradycardia <50 bpm or sinoatrial block Mobitz I second-degree atrioventricular block Mobitz II second or third-degree atrioventricular block Bundle-branch block Rapid paroxysmal supraventricular tachycardia or ventricular tachycardia Pre-excited QRS complexes Prolonged QT interval Brugada syndrome Arrhythmogenic right ventricular cardiomyopathy 3- Symptomatic orthostatic hypotension diagnosed by standing BP measurement 4- Non-syncopal loss of consciousness (e.g., epilepsy, psychiatric, metabolic, drop-attack, cerebral transient ischemic attack, intoxication, cataplexy) 5- Symptomatic cardio-inhibitory carotid sinus hypersensitivity |