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thank you very much so evolving concepts and this is certainly an area where the evidence is now pouring in and in fact at the end of my talk Ill give you the results of a new randomized trial presented yesterday now the heart rhythm society its absolutely bang in this area about EF and heart failure so Ill keep that right to the end and you just have to pay attention to my last slide but lots of interesting things going on in this space and you know the issue in your clinic some of these gets referred as this heart fear is it not you feel the pulse and its atrial fibrillation and your heart sinks because you know that theres so many more issues that youre gonna have to deal with do you have a time what are you going to prioritize how can you explain this to the patient so it does make it much more complicated in clinical practice but its a huge area of unmet need in terms of symptom control and actually changing the natural history of the condition so interesting medicine but
