Backgrounds: Because of the variable clinical characteristics, the definite treatment strategies for vasovagal syncope (VVS) have not been established. We analyzed the long term outcomes and clinical characteristics of VVS patients according to treatment modality and classification of positive response to head up tilt test(HUT). Methods: Total 256 patients (male: female=91:165, mean age: 36짹16 yrs) who showed positive HUT were enrolled. Mean follow up duration was 56짹39 months. Follow-up data were obtained by medical records and telephone interview. The definition of recurrence was the repeated syncopal attack and frequent (3 time/month) pre-syncopal symptoms during follow-up period. Positive response of HUT was defined according to modified VASIS classification. HUT protocol was used with a serial escalation of tilting table with isoproterenol infusion or not. Results: 1. There were five non-cardiac deaths. 2. 61 of 256 patients (23.8%) experienced the recurrence of VVS. 3. There was significant difference in the recurrence rate between treatment group and no-treatment group (7.6% vs 92.3%, p=0.002). 4. Type 1(mixed) was the most frequent type of positive HUT (type 1: 53.6%, type 2A: 8.3%, type 2B: 2%, type 3: 35.9%). 5. There was no significant difference of recurrence rate after treatment between four types of VASIS classification( type 1: 34.9%, type 2A:16.7%, type 2B:0%, type 3:31.0%, p=0.24 ). 6. Treatment group with beta-blocker was highly associated with symptom recurrence in younger patients (age<40 years) compared to no-treatment group (60.0% vs 10.5%:, p=0.01). Conclusion: Long term outcome in patients with VVS is favorable regardless of HUT classification. Initial beta blocker treatment seems to be not useful in younger patients and beta blocker should be cautiously prescribed.