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Vasovagal syncope (VVS) is a common disorder characterized by a drop in blood pressure accompanied with bradycardia; although it is generally considered a benign condition, some patients may be highly symptomatic despite general counselling and/or pharmacological therapy. Closed-loop stimulation (CLS), responding to myocardial contraction dynamics, demonstrated effectiveness in short-term prevention of recurrent VVS. The aim of this study was to evaluate CLS pacing in a long-term follow-up.The study involved 35 patients (mean age 59 ± 15 years) with 3 years’ follow-up (mean 61 ± 35 months). We compared syncopal events and presyncopes before and after CLS implantation. Mean number of syncopes for patients was six (range 1–24; 212 syncopal spells registered) before pacemaker implantation.At follow-up, 29 of 35 patients (83%) were asymptomatic; one patient experienced recurrent loss of consciousness but reported an improvement in the quality of life (one syncope or presyncope per month after CLS, vs. one syncope per week and daily presyncopes before CLS). Five patients experienced syncopal recurrences after CLS (range: 1–7, with a total of 15 episodes); in all the cases, the number of post-CLS syncopes was significantly lower.Our study seems to confirm previous results of short-term trials: DDDR-CLS pacing is an extremely useful tool in the prevention of recurring VVS, even in long-term follow-up.