OBJECTIVES: Syncope is a common medical event that accounts for 1-3% of all visits to the emergency departments (ED), hospitalizations and falls, and is associated with high morbidity and deterioration of quality-of-life. Conventional testing strategies fail to diagnose underlying causes in more than 1/3 of cases, leading to repeat episodes and costly healthcare system interactions. We sought to better understand the burden of unexplained syncope on four Provincial healthcare systems in Canada and evaluate the impact of adopting testing strategies centered on Insertable Cardiac Monitors (ICM) as an alternative to current practice. METHODS: We evaluated the economic burden and implications of alternative strategies for the provinces of Ontario, Quebec, British Columbia and Alberta using a multi-cohort Markov-based simulation model developed in Microsoft Excel. Our model was populated with data from peer-reviewed papers, CIHI Patient Cost Estimator, the StatsCan CANSIM database and physician schedules of fees. RESULTS: We estimate that between 2014 and 2023, syncope will affect 223,000 people each year across the four provinces, and account for 97,000 ED visits, 11,000 hospitalizations and 6,000 falls annually in this period. A total of 1.5 million diagnostic tests will be performed under conventional strategies, compared to 626 thousand tests if every syncope patient post-2014 were assigned ICM following an initial unsuccessful diagnosis (43% reduction). The ICM strategy would also eliminate 12% of blackouts, 9% of falls, and 21% of ED visits and hospitalizations related to Syncopal events. The proportion of patients diagnosed would increase from 15% to 47% at 36 months, and the strategy would be largely cost-neutral with an average annual reduction of $43M per year in Syncope-related expenditures. CONCLUSIONS: We find that the burden of unexplained Syncope on Canadian healthcare systems is substantial, and wider utilization of ICMs in diagnosis could reduce this burden while improving the patient experience.