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Background: Atrial fibrillation (AF) related symptoms are commonly reported but often difficult to directly correlate with arrhythmia. Given that symptoms largely drive management, correct patient awareness of AF is critical to implementation of appropriate therapy.Objective: To determine accuracy of patient identification of their own atrial rhythm.Methods: All AF patients in our center undergo patient reported outcome assessment with the Toronto AF Severity Scale (AFSS) immediately prior to clinic visit. Using the validated questions from the AFSS, we assessed if patients were able to accurately determine their rhythm (AF or not) compared to an electrocardiogram (ECG) during the same clinic visit.Results: We identified 254 unique patients (Table 1) with interpretable ECG and AFSS data available from the same visit. Based on ECG, 81% (n=206) were not in AF. 20 of these 206 patients (9.7%) incorrectly identified themselves in AF (Figure 1). Patients who incorrectly thought they were in AF were significantly older (p<0.05). Of the 48 (18.9%) that were in AF by ECG, 15 (31.2%) incorrectly identified themselves in sinus rhythm. There was no significant difference between sex, age or mean heart rate in patients in AF. Overall 14% (35 of 254) provided an assessment that was inconsistent with their ECG.Conclusion: Approximately one of ten patients incorrectly identified themselves as being in AF despite being in sinus rhythm. Without a standardized method to confirm if symptoms truly correlate with AF these patients may be at risk for unnecessary antiarrhythmic therapies. On the contrary, nearly a third of patients were unaware of AF which reemphasizes the incidence of asymptomatic AF.