Twenty-four patients with recurrent unexplained syncope and negative tilt and electrophysiologic testing underwent implantation of the implantable loop recorder, with recurrence of syncope in 21 patients 5.1+/-4.8 months after device implantation. Eighteen of the 21 had a treatable diagnosis, with arrhythmias in 11. Treatment resulted in resolution of syncope in most patients during long-term follow-up.