Athletes with syncope warrant a full evaluation, as it is possible that athletics may unmask heart disease, either structural or electrical, and these athletes may be at risk for sudden cardiac death. The work-up and treatment of syncope in the athlete offers some unique challenges: to diagnose potentially life-threatening arrhythmias, to avoid pharmacological therapy, and to maximize ability to play. This article addresses the topic of syncope and possible solutions for those athletes in whom it is diagnosed.