Abstract Body (Do not enter title and authors here): Introduction
Reported symptomatic activations by patients who are prescribed Holter monitors often do not correlate with true arrhythmia, and recorded ectopy is often asymptomatic. The prevalence of symptom-arrhythmia association (SAA) and relation with age, sex, and underlying co-morbidities are not well described.

Goals
Identify the overall likelihood of symptoms being associated with true arrhythmia. Identify patient characteristics associated with SAA.

Methods
In this retrospective chart review, extended Holter recordings (analyzable data >72 hrs) from 100 consecutive patients (Apr-Jul 2023) were selected. Patients activated the monitor when they experienced an arrhythmia-related symptom. Holters with excessive artifact and <2 symptomatic activations were excluded. Accuracy was defined as the percent of activations associated with arrhythmia (APB, VPB, SVT, VT, 2nd/3rd degree AV block, or sinus exit block). We defined “SAA” as accuracy greater than zero.
Patient characteristics were characterized as mean or percent (Table I). The relationship between important predictor variables and the presence of SAA was further explored using logistic regression (adjusting for sex, race, analysis duration, comorbidities and ectopy percent, Table II). Analyses were run in RStudio R 4.2.1.

Results
For 100 patients (mean age: 55±18, 27% male, 66% Caucasian), the average accuracy was 22%. Of the 100 patients, 42 had SAA. On univariate analyses, patients with SAA were more likely to be older, have a lower LVEF, and be on cardioactive medications. None of these associations were significant after multivariable adjustment for variables shown in Table II. There was no difference in the percentage of females, percent Caucasians, presence of MVP, or the number of symptomatic activations in those with SAA versus without.

Conclusion
The average probability of a symptomatic event during Holter recording being associated with a true rhythm disturbance was 22% and only 42% of patients demonstrated any SAA. There was no association between SAA and sex, number of symptomatic activations, or the presence of MVP.