BACKGROUND: Although vasovagal syncope is most common cause of syncope, treatment for vasovagal syncope has been not well established. We assessed the hypothesis that the efficacy of intensive education is as effective as that of conventional treatment. So, we have carried out the study on intensive education efficacy. METHODS: A total of 422 subjects who were diagnosed with vasovagal syncope by head-up tilt test from May 2006 to Oct 2009 were investigated retrospectively. Group 1(n=213, 50.5%) were treated with only intensive education. Group 2 (n=209, 49.5%) received conventional treatment of medication plus routine explanation; beta-blocker(n=132, 63.2%), midodrine (n=71, 34%), and paroxetine (n=6, 2.8%). All patients involved this study were provided to intensive education regarding supine position at the onset of symptom, avoidance of triggering event, and lifestyle modification. We classified severity grade during syncope according to accident severity (grade 0 : no traumatic lesion , grade 1 : slight contusion, grade 2: severe damage demanding other surgery part treatment). 345 of 422 subjects were interviewed with telephone during mean 2.4 years follow-up and 77 visited regularly at outpatient clinic. We assessed predisposing factor for recurrent syncope by multiple logistic regression analysis and propensity score. Results: Gender, congestive heart failure history, diabetes, accident severity, and the frequency of syncope were not different between groups (all p values >0.05). Group 2 was older(37.73 vs 46.94, p<0.05), had more hypertension(12 vs 62, p<0.05), coronary disease(3 vs 17, p<0.05) and old stroke(1 vs 12, p<0.05) than group1. After a follow-up of 29짹9.7 months, the frequency of syncope episodes after treatment reduced from 2.22짹1.90 to 0.17짹1.08 in group1 (p<0.05), and that reduced from 1.99짹1.77 to 0.18짹0.59 in group 2 (p<0.05). The efficacy among three drug type was not different (p=0.59). In multivariate regression analysis with propensity score, young age <45 (OR 2.35, 95% CI 1.11-4.99, p-value=0.02) and previous syncope episodes >4 (OR 3.39, 95% CI 1.29-8.89, p-value=0.01) were independent predictors of syncope recurrence, and intensive education was not associated with increased risk of syncope recurrence. Conclusions: The efficacy of intensive education as treatment of vasovagal syncope recurrence was not different from that of conventional medical treatment. And young age (<45) and multiple previous syncope episodes were independent predictors of recurrent syncope after treatment.