Vasovagal syncope is one of the most common forms of syncope.There are limited drug therapy options for patients with cardiosuppressive syncope,and permanent pacemaker therapy is recommended.This article reviews the tortuous development of pacemaker implication in the treatment of vasovagal syncope and summarizes the underlying reasons,and potential patients,who might benefit from pacing therapy and the limitations of its application according to the current guidelines.In the future,cardioneuroablation might become a therapeutic choice for patients with vasovagal syncope,the safety,efficacy and suitable patinets groups need to be validated in coming large sample randomized controlled clinical trials.