Vasovagal syncope (VVS) continues to be the most frequent cause of syncope in all age groups. Recent ran-domized double-blinded trials (RCTs) provide further support for pacing in selected cases of patients with recurrent refractory VVS with significant cardio-inhibitory response either documented spontaneously or induced during head-up tilt testing (HUTT). Cardiac pacing is the only therapy of proven efficacy for the pre -dominant cardio-inhibitory phenotype of vasovagal (reflex) syncope; however, several questions regarding the best candidates remain. The current review focuses on practical tips for use of cardiac pacing in practice.