Tilt twining therapy is considered as a first choice treatment for neurocardiogenic syncope in the Department of Cardiology, University of Leuven. However, long-term compliance to therapy may be difficult when patients become asymptomatic. In a single center uncontrolled study, the long-term clinical outcome of 38 patients was studied after a follow-up period of 43 +/- 7.8 months. At the time of assessment 29 patients had abandoned tilt twining therapy, while 9 still continued on a regular basis. In this series, 31 (82%) of 38 patients were free from syncope and 25 (66%) of 38 were completely asymptomatic. During follow-up, seven patients reported the recurrence of at least one syncope. Of these seven patients, six had discontinued tilt training therapy. The number of syncopes after discontinuation was significantly lower as compared with the period before initiation of tilt twining. In only one patient syncope recurrence was observed during rather irregular tilt training therapy. Moreover, in 19 patients who abandoned tilt training after about 1 year, no syncope recurrence was reported during daily life, which suggests that the disturbed autonomic reflex activity in these patients may have been restored.