Syncope Trial to Understand Tilt Testing or ECG Recording Tenth Prevention of Syncope Trial

Inclusion Criteria: * age \>50 years old * ≥1 syncope26 in the prior 12 months * diagnosis unclear after history, physical exam, and electrocardiogram * no apparent risk of death due to the cause of syncope Exclusion Criteria: * cannot provide informed consent or attend routine follow up * have known left ventricular ejection fraction \< 50%,or have * pacemaker, ICD, or ICM * Class I indication for permanent pacing or ICD implantation * hypertrophic cardiomyopathy * a history of myocardial infarction within 3 months prior to enrolment * a major chronic co-morbid medical condition that would preclude 12 months of follow-up * bifascicular block * epilepsy proven by electroencephalography * syncope of known cause