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I posted about this previously - did not get much traction :) I am sure someone will go ahead and refute or prove this in a trial or looking back at the data.

My clinical observation has been that the presence of beta-blockers, used for another indication (e.g. HTN), lowers the probability of detecting A Fib in a patient that presents with ESUS. Therefore, given the results of the recent ARCADIA trial read more here, there is a suggestion that some markers of atrialcardiopathy may not be sufficient to detect the propensity of identifying those that may benefit from anticoagulation - note I don’t mean all biomarkers., some more useful than others, and some may cloud detection ability in a clinical trial. However, I suspect, the presence of BBs also modulates the detection of A Fib, and those with LA dilatation (best via the LAVI, volume index), and embolic stroke, who are on BB, I suspect these patients actually have a high probability of A fib, and thus the search should be on to find it. BB can reduce the probability of detection - I cannot find any papers that directly show this - but I have found this to be the case clinically over and over again. I also cannot reliably find reporting of BB use in A Fib large detection trials. There is some biologic plausability. Here is some “smoke” looking at the HR distributions with BB on-board, see this. The awesome point about this paper and other papers that are cited here are the fact that they show the complexity that we have with A Fib and how it is more than just atriopathy, but certainly involves HFpEF, chronic HTN, size and shape of the LAA, time in/out of A Fib, and even how medications used for HTN can modify intra-cardiac pressues to promote the development of A Fib - the cool-factor is that it is very intriguing and shows how no algebreic simple score can capture true risk of A Fib and risk of stroke from A Fib, as always, our models are approximations to what actually occures in nature. I am sure we will see more on this topic in the future! Given how complex A Fib is, it is not surprising its complexity cannot be captured via a simple algebreic sum of terms.

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