The electrocardiogram has diagnostic and prognostic value in the evaluation of syncope, and consensus guidelines suggest routine electrocardiographic testing. An analysis of a nationally representative survey suggests that electrocardiographic testing is performed inconsistently in patients presenting with syncope to United States emergency departments, even in high-risk patients, such as the elderly and hospitalized. Variation in electrocardiographic testing represents an opportunity to improve the care of patients presenting with syncope to emergency departments.