The issue of the contribution of carotid sinus massage (CSM) to the diagnosis of syncope remains unsettled. When recurrent syncope falls, or both remain unexplained after a careful initial evaluation, including a detailed history, physical examination and standard electrocardiogram, the guidelines of the European Society of Cardiology recommend that a tilt test be conducted in young patients and CSM in older patients.¹ In previous guidelines, patients aged >40 years were eligible for CSM.² The retrospective study reported by Humm and Mathias (see …