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Neurally mediated syncope (also known as vasovagal or neurocardiogenic syncope) is a perplexing disorder. Its pathophysiology is incompletely understood, and therapeutic interventions have had inconsistent success. Kaufmann and colleagues investigated this disorder in a manufacturer-sponsored trial using the α-agonist midodrine to treat tilt-table-induced, neurally mediated syncope in 12 patients. All patients had experienced at least 2 syncopal episodes during the previous year and had an acute hypotensive episode with absolute or relative bradycardia reproduced on the tilt table. The double-blind, randomized, crossover study entailed the administration of a nonpressor dose (5 mg) of midodrine or placebo one hour prior to tilt-table testin…