The vasovagal syncope is a frequent entity of difficult management with a high rate of recurrence despite medical management. Cardiac pacing has been studied in patients with cardioinhibitory response on tilt table with inconsistent results. Initial studies showed beneficial results were achieved, but they could be reproduced when the double-blind design was introduced. Most of these studies were performed with conventional pacemaker sensors. Device current guidelines indicate pacing therapy in vasovagal syncope with cardioinhibitory response as an alternative to non-response to conventional therapy. There is recent evidence that pacemakers with closed-loop sensors (CLS) show better results than conventional sensors; these studies, although limited to small groups of population, show reductions in the frequency of syncopes and presyncopes. These devices work in earlier stages of the cascade of pathophysiological events of the vasovagal syncope, detecting changes in ventricular impedance before the fall in heart rate, thus allowing early intervention as stimulation to prevent syncope.