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As no specific therapy is effective for all types of non-cardiac syncope, identifying the underlying haemodynamic mechanism is the essential prerequisite for an effective personalized therapy and prevention of syncope recurrences. Indeed, choice of appropriate therapy and its efficacy are largely determined by the syncope mechanism rather than its aetiology and clinical presentation. The two main haemodynamic phenomena leading to non-cardiac syncope include either profound hypotension or extrinsic asystole\/pronounced bradycardia, corresponding to two different haemodynamic syncope phenotypes, the hypotensive and bradycardic phenotypes. The choice of therapy\u2014aimed at counteracting hypotension or bradycardia\u2014depends on the given phenotype. Discontinuation of blood pressure\u2013lowering drugs, elastic garments, and blood pressure\u2013elevating agents such as fludrocortisone and midodrine are the most effective therapies in patients with hypotensive phenotype. Cardiac pacing, cardioneuroablation, and drugs preventing bradycardia such as theophylline are the most effective therapies in patients with bradycardic phenotype of extrinsic cause.<\/jats:p>","DOI":"10.1093\/europace\/euae073","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T11:50:06Z","timestamp":1711453806000},"source":"Crossref","is-referenced-by-count":13,"title":["Mechanism-based therapy of non-cardiac syncope: a practical guide"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1845-5607","authenticated-orcid":false,"given":"Michele","family":"Brignole","sequence":"first","affiliation":[{"name":"IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Department of Cardiology, S. 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