Great. Thank you. So e going to talk a little bit about anti quagulation m as it relates to the c c s guid lines. So in the c c s guide lines, we know for stroke prevention, anyone with a chads, two of one, or if they're 65 years or older, receive anti quagulation. In 20 18, the patients with sub clinical atal febrilation lasting more than 24 hours, or high risk stroke with shorter duration, are treated with oral anti quagulente, can you expand on the evolution of the scoring criteria for anti quagulation in atral februlation and the evidence behind this? Sa

isa is an excellent costion because is one of the most often senaros that we deal with as electro physiologists. The reason is that we manage patients wirh paste makers. And if you have an atral lead, it's going to see ina detect lookat ste atrum 24, seven, three, 65. So because of that, when we interrogate patients devices, we often get these episodes of fib detected by the lead, lasting for minutes or several hours. And it's one of the things that always, we always ask about, if someone has a little bit of a fib, like a few minutes, even a few hours, in over a year of monitoring, do these patients need anticoagulation? I think the first hint that these that this is actually clinically relevant, just even a little bit of a fip, stems from the asert tril which was stunned by doctor jeff healey from hamilton. So in that trial, he enroled about two thousand patients who have a pace maker's with an atal lead, and then he followed these patients over in several years, an sas ener the outcomes for patients who develop a pace micker detected ata forpelation versus nots. And the bottom line is that any patients with the pace miker detected a lasting more than six minutes, actually have an increased risk of stroke compared to those without. And in particular, when they do the subcropn s, patients who have be na continuous apib lasting more than 24 hours, detected by the device or havi, have the highest risk of stroke compared to people with less pasmiett a versus nine. So this kind of forms the basis fo for anticoagulating. Having said that, the definitive random as trial showing whether andclagulating these short, sub clinical episodes have not been completed. Its called the artesia trial, also of being headed by doctor jff. Healy in rome. It has completed four thousand patients ofly. In the next two to three years, the trial will be presented, and definitely will be a high impact trial. So that trial randomized patients with pase micket detected apip less than 24 hours to either apexaban or aspiran in a double blind fashion. So so that would give us good insight as to whether anticoaglating these shorter, in sub clinical paste micket detected afip episodes, wod, would be help neutral or harmful. Because there is some new data. There's something called the lop trial. It was published in te lancet. It was presented in the american hert association, late breaking trial in two thousand 21, there's a hint that, ouknow, we don't necessarily have to antiquaglate people with short duration a episode, even though they have wrist factors of stroke. So it's an evolving field right now. When you look at the c c s skylines, they do recommend a anti coagulating people with wrist factors for stroke, like a high child score tet's say, a with sub clinical a f lasting more than 24 hours. But it's still, the evidence is not that strong. And fully, in two to three years it'll be better. So, you know, given that this is the best we have in terms of guyline, i would stick with that. You know, if someone hasave really high wrists for stroke, let's say, let's say they present it with cardo embolic stroke, and you do see some a fib even though it's only an hour or minutes, i think right now the clinical practice is to lean towards anticoagin as s to not given that if there's a strong sense thet afip is responsible for some degree of arterial formor embalism, already, that's

really helfful background.