[Neurocardiac syncope: pathophysiology, diagnosis, therapy].

The diagnostic work-up and the appropriate therapy of patients with recurrent syncopy represents an often encountered clinical problem. The underlying etiology of a syncopal episode remains not infrequently unknown despite intensive and sometimes costly diagnostic procedures. Particularly in young patients with syncopal attacks, the diagnosis of neurocardiogenic syncope has been established on the basis of normal findings during conventional cardiologic and neurologic work-up. Only since the introduction of the tilt-table test into clinical practice has the clinician had a diagnostic tool to prove the neurocardiogenic etiology of a syncopal episode. It has been demonstrated that this diagnostic method yields a good reproducibility which makes it suitable to assess the efficacy of therapeutic interventions. There have been several therapeutic recommendations according to the multifactorial pathogenesis of neurocardiogenic syncope. Among these, therapy with beta-receptor blocking agents or with theophylline appears to be the most promising treatment modalities. The results obtained in the studies reviewed in the present article have increased our knowledge with respect to the pathogenesis of neurocardiogenic syncope as well as the diagnostic procedures and treatment modalities in patients afflicted with this disorder.