Abstract
Management of recurrent syncope can be challenging to both physicians as well as to the patients. With limited data showing the benefits of any of any particular treatment in patients with Neurocardiogenic syncope (NCS), therapy may not be successful in all cases and recurrence of syncope can be both frustrating for the patient as well as the treating physician. Physical injuries and substantial psychological issues resulting from these difficult to manage and recurrent episodes of syncope are commonly seen in these patients and can severely affect their quality of life. This article provides an overview of some probable cause of difficult to manage syncope, how to recognize them and outlines the use of some management strategies which we believe have worked well in these cases.