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1. Ventricular Arrhythmias in Left Ventricular Assist Device Patients—Current Diagnostic and Therapeutic Considerations

Author

Laura Załucka, Ewa Świerżyńska, Michał Orczykowski, Krzysztof Dutkowski, Jarosław Szymański, Jarosław Kuriata, Rafał Dąbrowski, Piotr Kołsut, Łukasz Szumowski, and Maciej Sterliński

Subjects
ECG, heart failure, left ventricular assist device, arrhythmia, Holter ECG, Chemical technology, TP1-1185
Abstract

Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.

Published
2024
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2. A combination of quinidine/mexiletine reduces arrhythmia in dilated cardiomyopathy in two patients with R814W SCN5A mutation

Author

Joanna Zakrzewska‐Koperska, Zofia T. Bilińska, Grażyna T. Truszkowska, Maria Franaszczyk, Waldemar Elikowski, Grzegorz Warmiński, Katarzyna Kalin, Piotr Urbanek, Robert Bodalski, Michał Orczykowski, Łukasz Szumowski, Rafał Płoski, and Maria Bilińska

Subjects
R814W SCN5A variant, Arrhythmogenic dilated cardiomyopathy, Multifocal ectopic Purkinje‐related premature contractions, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract SCN5A gene mutations are described in 2% of patients with dilated cardiomyopathy (DCM) and different rhythm disturbances, including multifocal ectopic Purkinje‐related premature contractions. Recent data indicate that sodium channel blockers are particularly effective monotherapy in carriers of the R222Q SCN5A variant. Our purpose is to describe the effectiveness of antiarrhythmic treatment in a family with genetically determined arrhythmogenic DCM associated with the R814W variant in the SCN5A gene. We examined a family with arrhythmogenic DCM (multifocal ectopic Purkinje‐related premature contractions phenotype, atrial tachyarrhythmias, automatism, and conduction disorders) and described antiarrhythmic treatment efficacy in heart failure symptoms reduction and myocardial function improvement. We found a heterozygotic mutation R814W in SCN5A by whole exome sequencing in the proband and confirmed its presence in all affected subjects. There were two sudden cardiac deaths and one heart transplantation among first‐degree relatives. The 58‐year‐old father and his 37‐year‐old daughter had full spectrum of symptoms associated with R814W SCN5A mutation. Both had implanted cardioverter defibrillator. In the father, adding mexiletine to quinidine therapy reduced ventricular arrhythmia (50–60% → 6–8% of whole rhythm) and reverted long‐standing atrial fibrillation to sinus rhythm. In the daughter, mexiletine and overdrive pacing were effective in ventricular arrhythmia reduction (25% → 0.01%). Because of a growing number of atrial fibrillation recurrences, a reduced dose of quinidine (subsequently flecainide) was added, resulting in arrhythmia significant reduction. In both cases, antiarrhythmic effectiveness correlated with clinical improvement. In SCN5A R814W‐associated DCM, a combination of Class I antiarrhythmics and overdrive pacing is an effective treatment of severe ventricular and atrial arrhythmias.

Published
2020
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3. Occupational risks for SARS-CoV-2 infection: the Polish experience

Author

Radosław Sierpiński, Jaroslaw Pinkas, Mateusz Jankowski, Grzegorz Juszczyk, Roman Topór-Mądry, and Łukasz Szumowski

Subjects
occupational exposure, public health, quarantine, coronavirus infection, patient isolation, cross-sectional survey, Medicine
Abstract

Objectives The disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed COVID-19, is asymptomatic or mild in most cases. These patients do not need treatment in hospital and can be isolated at home. To date, most studies have been conducted among inpatients with severe COVID-19. In this study, the authors surveyed patients with mild COVID-19 who remained in home isolation, and analyzed the sources and occupational risk factors for SARS-CoV-2 infections. Material and Methods This cross-sectional study was carried out on April 17–18, 2020, among patients infected with SARS-CoV-2 who remained in home isolation in Poland. Data were acquired through a structured interview that included questions about the isolation course, symptoms, comorbidities, infection source, household characteristics, occupation, and workplace. Data were presented with descriptive statistics. Results Of the 4878 patients in home isolation, the authors were able to contact 3313. Of them, 1191 patients declined their invitation, and 2122 agreed to take part. The median age of the patients included in the study was 50 years; 59% were female. Most patients (92%) had not been abroad before the infection. More than half (55%) knew how they became infected; of them, 75% became infected at work. Of all patients, 70% were occupationally active. Nearly half of the occupationally active patients (48%) worked in healthcare, 3% worked in public administration or defense, 3% worked in transportation, and 2% worked in education. Sixty-five percent of the occupationally active patients worked in companies with >100 employees. Conclusions Most of the patients with COVID-19 in home isolation in Poland were occupationally active, wherein the majority of people who were aware of the source of SARS-CoV-2 infection worked in healthcare. As most of the infected patients worked in companies with >100 employees, which is not a Polish employment pattern, the authors expect that smaller companies may have a lower risk of SARS-CoV-2 infections. Int J Occup Med Environ Health. 2020;33(6):781–9

Published
2020
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4. Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications

Author

Ewa Świerżyńska, Artur Oręziak, Renata Główczyńska, Antonio Rossillo, Marcin Grabowski, Łukasz Szumowski, Francesco Caprioglio, and Maciej Sterliński

Subjects
cardiac pacemakers, rate response, chronotropic incompetence, physical exercise, physical capacity, Chemical technology, TP1-1185
Abstract

Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart’s work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient’s real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms.

Published
2023
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5. Cardiac resynchronization in Poland – comparable procedural routines? Insights from CRT Survey II

Author

Mateusz Tajstra, Damian Łasocha, Elżbieta Gadula-Gacek, Mateusz Ostręga, Lidia Michalak, Dariusz Wojciechowski, Marek Zieliński, Maciej Kempa, Zbigniew Orski, Anna Polewczyk, Jerzy Ozga, Camilla Normand, Kenneth Dickstein, Cecilia Linde, Jarosław Kaźmierczak, Łukasz Szumowski, Mariusz Gąsior, and Maciej Sterliński

Subjects
cardiac resynchronisation therapy, chronic heart failure, survey, Medicine
Published
2019
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6. Rapid and effective response of the R222Q SCN5A to quinidine treatment in a patient with Purkinje-related ventricular arrhythmia and familial dilated cardiomyopathy: a case report

Author

Joanna Zakrzewska-Koperska, Maria Franaszczyk, Zofia Bilińska, Grażyna Truszkowska, Małgorzata Karczmarz, Łukasz Szumowski, Tomasz Zieliński, Rafał Płoski, and Maria Bilińska

Subjects
SCN5A, Nav1.5, Dilated cardiomyopathy, Multifocal ectopic Purkinje-related premature contractions, Internal medicine, RC31-1245, Genetics, QH426-470
Abstract

Abstract Background Mutations of the SCN5A gene are reported in 2-4% of patients with dilated cardiomyopathy (DCM). In such cases, DCM is associated with different rhythm disturbances such as the multifocal ectopic Purkinje-related premature contractions and atrial fibrillation. Arrhythmia often occurs at a young age and is the first symptom of heart disease. Case presentation We present the case of 55-year old male with a 30-year history of heart failure (HF) in the course of familial DCM and complex ventricular tachyarrhythmias, which constituted 50-80% of the whole rhythm. The patient was qualified for heart transplantation because of the increasing symptoms of HF. We revealed the heterozygotic R222Q mutation in SCN5A by means of whole exome sequencing. After the quinidine treatment, a rapid and significant reduction of ventricular tachyarrhythmias and an improvement in the myocardial function were observed and this effect remained constant in the 2.5-year follow-up. This effect was observed even in the presence of concomitant coronary artery disease. Conclusions Patients with familial DCM and Purkinje-related ventricular arrhythmias should be offered genetic screening. The quinidine treatment for the SCN5A R222Q mutation can be life saving for patients.

Published
2018
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8. Flecainide in clinical practice

Author

Mikołaj Basza, Cezary Maciejewski, Wojciech Bojanowicz, Paweł Balsam, Marcin Grabowski, Przemysław Mitkowski, Maciej Kempa, Oskar Kowalski, Zbigniew Kalarus, Miłosz Jaguszewski, Andrzej Lubiński, Ludmiła Daniłowicz-Szymanowicz, Łukasz Szumowski, Maciej Sterliński, and Łukasz Kołtowski

Subjects
General Medicine, Cardiology and Cardiovascular Medicine
Published
2023
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9. Purkinje triggers of ventricular fibrillation in patients with hypertrophic cardiomyopathy

Author

Josselin Duchateau, Nicolas Derval, Thomas Pambrun, Philippe Maury, Michel Haïssaguerre, Łukasz Szumowski, Mélèze Hocini, Pierre Jaïs, Frederic Sacher, Hubert Cochet, F. Daniel Ramirez, and Ghassen Cheniti

Subjects
Adult, medicine.medical_specialty, Adolescent, Radiofrequency ablation, medicine.medical_treatment, Population, Catheter ablation, 030204 cardiovascular system & hematology, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, law, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, Child, education, education.field_of_study, business.industry, Hypertrophic cardiomyopathy, Cardiomyopathy, Hypertrophic, Ablation, medicine.disease, Ventricular Premature Complexes, Defibrillators, Implantable, medicine.anatomical_structure, Ventricle, Ventricular Fibrillation, Ventricular fibrillation, Catheter Ablation, Cardiology, Female, Electrical conduction system of the heart, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction Ventricular fibrillation (VF) is the main mechanism of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). The origin of VF and the success of catheter ablation to eliminate recurrent episodes in this population are poorly understood. Methods and results From 2010 to 2014, five patients with HCM (age 21 ± 9 years, three female) underwent invasive electrophysiological studies and ablation at our center after resuscitation from recurrent (9 ± 7) episodes of VF. Ventricular premature beats (VPBs), seen to initiate VF in certain cases, were recorded noninvasively before the ablation procedure. Postprocedural computed tomography (CT) was performed to correlate ablation sites with myocardial hypertrophy in three patients. Outcomes were assessed by clinical follow-up and implantable cardioverter-defibrillator interrogations. VPB triggers were localized invasively to the distal left Purkinje conduction system (left posterior fascicle [2], left anterior fascicle [1], and both fascicles [2]). All targeted VF triggers were successfully eliminated by radiofrequency ablation in the left ventricle. Among patients with postablation CT imaging, 93 ± 12% of ablation sites corresponded to hypertrophied segments. Over 50 ± 38 months, four of five patients were free from primary VF without antiarrhythmic drug therapy. One patient who had 13 episodes of VF before ablation had a single recurrence. Conclusion In our study of patients with HCM and recurrent VF, VF was not initiated from the myocardium but rather from Purkinje arborization. These sources colocalized with the hypertrophic substrate, suggesting electromechanical interaction. Focal ablation at these sites was associated with a marked reduction in VF burden.

Published
2021
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10. Use of an exercise test to enhance sensing vector assessment and prevent inadequate subcutaneous implantable cardioverter-defibrillator discharges

Author

Łukasz Szumowski, Maciej Sterliński, Paweł Syska, Ewa Świerżyńska, and Krzysztof Sadowski

Subjects
medicine.medical_specialty, Bundle branch block, business.industry, medicine.medical_treatment, Electric Countershock, Wide QRS complex, 030204 cardiovascular system & hematology, Implantable cardioverter-defibrillator, medicine.disease, Defibrillators, Implantable, Test (assessment), Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Heart rate, Exercise Test, Cardiology, medicine, Humans, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Subcutaneous implantable cardioverter-defibrillators are a modern alternative to classic cardioverter-defibrillators. Prior to implantation of the device, qualification based on assessment of the heart's specific rhythm shape during a resting electrocardiogram examination must be performed. In the presented case, a patient with a subcutaneous implantable cardioverter-defibrillator experienced numerous discharges during exercise. An exercise test was performed, which revealed a bundle branch block that appeared during exercise. The wide QRS complex was double- or triple-counted by the device, resulting in an inaccurate heart rate estimation and multiple discharges. Optimising the sensing vectors during exercise solved this problem.

Published
2021
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11. Association of left atrial enlargement and increased left ventricular wall thickness with arrhythmia recurrence after cryoballoon ablation for atrial fibrillation

Author

Grzegorz Warmiński, Piotr Urbanek, Michał Orczykowski, Robert Bodalski, Łukasz Kalińczuk, Kamil Zieliński, Gary S Mintz, Zbigniew Jedynak, Andrzej Hasiec, Joanna Zakrzewska-Koperska, Ilona Michałowska, Ilona Kowalik, Hubert Łazarczyk, Maciej Sterliński, Maria Bilińska, Paweł Pławiak, and Łukasz Szumowski

Subjects
Male, Treatment Outcome, Recurrence, Pulmonary Veins, Atrial Fibrillation, Catheter Ablation, Humans, Female, Middle Aged, Cardiology and Cardiovascular Medicine, Cardiomyopathies, Cryosurgery, Aged
Abstract

Left atrial enlargement (LAE) predicts atrial fibrillation (AF) recurrence after cryoballoon-based pulmonary vein isolation (CB). Increased left ventricular wall thickness (LVWT) is pathophysiologically associated with LAE and atrial arrhythmias.To assess effect of increased LVWT on long-term outcomes of CB depending on coexistence of LAE.LAE was defined using either echocardiography (48 cm³/m²) or multislice computer tomography (MSCT, ≥63 cm³/m²). Increased LVWT was echocardiographic septal/posterior wall thickness10 mm in males and9 mm in females. All patients achieved 2-year follow-up.Of 250 patients (median [interquartile range, IQR] age of 61 [49.0-67.3] years; 30% female) with AF (40% non-paroxysmal), 66.5% had hypertension, and 27.2% underwent redo procedure. MSCT was done in 76%. During follow-up of 24.5 (IQR, 6.0-31.00) months the clinical success rate was 72%, despite 46% of patients having arrhythmia recurrence. Arrhythmia recurrence risk was increased by LAE and increased LVWT (hazard ratio [HR], 1.801; P = 0.002 and HR, 1.495; P = 0.036; respectively). The highest arrhythmia recurrence (61.9% at 2 years) was among patients with LAE and increased LVWT (33.6% of patients); intermediate (41.8%) among patients with isolated LAE; and lowest among patients with isolated increased LVWT or patients without LAE or increased LVWT (36.8% and 35.2% respectively, P = 0.004). After adjustment for body mass index (BMI), paroxysmal AF, CHA₂DS₂-VASc score, clinically-significant valvular heart disease, and cardiomyopathy, patients with LAE and concomitant increased LVWT diagnosis had a 1.8-times increased risk of arrhythmia recurrence (HR, 1.784; 95% confidence interval [CI], 1.017-3.130; P = 0.043).Joint occurrence of LAE and increased LVWT is associated with the highest rate of arrhythmia recurrence after CB for AF.

Published
2022

12. Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience

Author

Adam Witkowski, Ewa Kowalik, Tomasz Zieliński, Małgorzata Sobieszczańska-Małek, Piotr Urbanek, Adam Banasiak, Jarosław Skowroński, Joanna Wiśniewska, Łukasz Szumowski, Adam Parulski, Piotr Hoffman, and Jan Paweł Jastrzębski

Subjects
medicine.medical_specialty, Hypertension, Pulmonary, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, 030212 general & internal medicine, Heart Failure, Heart transplantation, Ejection fraction, business.industry, Stroke Volume, General Medicine, medicine.disease, Denervation, Pulmonary hypertension, Treatment Outcome, Blood pressure, medicine.anatomical_structure, Heart failure, Pulmonary artery, Cardiology, Vascular resistance, Vascular Resistance, Cardiology and Cardiovascular Medicine, business, Transpulmonary pressure
Abstract

Objectives The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF). Background Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. Methods The combination of pulmonary artery systolic pressure (PAPs) ≥60 mmHg, transpulmonary pressure gradient (TPG) ≥12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) ≥3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6 months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45°C and energy 10 W. Results TPADN was performed in 10 patients. At 6-month in 5 patients we observed reduction in PAP, PVR, TPG, and DPG and then 1 had successful HTx, 2 are on HTx waiting list, 2 received LVADs, 2 patients did not improve, and 3 patients died. Conclusions TPADN may be beneficial in selected patients with HF-rEF and Cpc-PH.

Published
2021
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13. Association between the acquisition of antibodies against Lyme disease and the risk of atrial arrhythmias

Author

Andrzej Hasiec, Rafał Wolny, Bartosz Duda, Grzegorz Warmiński, Ilona Kowalik, Ewa Walczak, Maria Bilińska, Piotr Urbanek, Robert Bodalski, Michał Orczykowski, Maciej Sterliński, and Łukasz Szumowski

Subjects
Lyme Disease, Atrial Fibrillation, Internal Medicine, Humans
Abstract

The impact of antibodies against Borrelia burgdorferi (BB) on the occurrence of cardiac arrhythmias in patients without typical symptoms of Lyme disease (LD) is largely unknown.We aimed to assess the risk of atrial fibrillation (AF) and other atrial arrhythmias (AAs) in patients who tested positive for anti-LD antibodies.We included consecutive patients referred for the diagnosis and treatment of AAs who had no history of erythema migrans or other symptoms of LD. The presence of anti-BB antibodies (immunoglobulin [Ig] M and IgG) was assessed in each patient, and the diagnostic workup of cardiac arrhythmias was performed.Of the 527 patients enrolled in the study, 292 (55%) were diagnosed with AAs, and we detected BB antibodies in 131 individuals (24.8%). The patients with a serological history of Borrelia infection were older (mean [SD], 55.6 [15.7] vs 50.3 [18.6] years; P = 0.01), had a higher probability of developing AF or other supraventricular arrhythmias (SAs) (66.4% vs 51.8%; P = 0.03), and had elevated levels of N‑terminal pro-B ‑type natriuretic peptide (NT‑proBNP) (58% vs 47.5%; P = 0.04). We also found an as-sociation between the occurrence of AF and other SAs in patients with anti-BB antibodies and elevated NT‑proBNP values, and the risk of AAs in these patients increased almost 3‑fold (P = 0.01).Our data indicated an association between the exposure to Borrelia infection and the risk for AF and other AAs in the patients with elevated levels of NT‑proBNP, suggesting the need for a more efficacious diagnostic approach to patients with SAs, especially in LD‑endemic regions.

Published
2022

14. Prediction of early death after myocardial infarction in patients with reduced left ventricular ejection fraction. The search for new indications for cardioverter-defibrillator implantation (ICD)

Author

Damian Pres, Mateusz Tajstra, Przemysław Mitkowski, Aneta Ciślak, Kamil Bujak, Jarosław Kaźmierczak, Maciej Sterliński, Katarzyna Mizia-Stec, Radosław Sierpiński, Mariusz Gąsior, Łukasz Szumowski, and Zbigniew Kalarus

Subjects
Death, Sudden, Cardiac, Percutaneous Coronary Intervention, Risk Factors, Myocardial Infarction, Humans, Stroke Volume, Cardiology and Cardiovascular Medicine, Ventricular Function, Left, Defibrillators, Defibrillators, Implantable
Abstract

The highest rate of death is in the first few weeks after myocardial infarction (MI). However, the assessment of indications for primary prevention implantable cardioverter-defibrillator (ICD) implantation should be postponed until at least 40 days after MI.Our aim was to identify the subgroup of high-risk patients with reduced left ventricular ejection fraction (LVEF) who would benefit from primary prevention ICD implantation within 40 days of MI.Out of 205 606 patients with MI, in this study, we included 18 736 patients treated invasively, with LVEF40%, who survived until hospital discharge. Patients were divided into two groups according to the survival status at 40 days - patients who died within this period (n = 1331) and patients who survived (n = 17405).Among all patients who died within 12-months after MI, 37.7% did die during the first 40 days. Patients with cardiac arrest before hospital admission or within the first 48 hours of hospitalization (hazard ratio [HR], 3.35; 95% confidence interval [CI], 2.82-3.98; P0.0001], cardiogenic shock before admission or during hospitalization (HR, 3.06; 95% CI, 2.62-3.59; P0.0001), unsuccessful percutaneous coronary interventions (PCI; HR, 2.42; 95% CI, 2.11-2.84; P0.0001), LVEF20% (ref. LVEF ≥30%; HR, 2.75; 95% CI, 2.25-3.36; P0.0001) had approximately threefold and patients with chronic kidney disease almost 1.5-times (HR, 1.25; 95% CI, 1.47-3.59; P = 0.0053) higher 40-day mortality compared to patients without these risk factors. The most striking differences in mortality between these subgroups were observed shortly after discharge.The highest risk of death in patients with reduced LVEF who survived until hospital discharge occurred within the first 40 days after MI. There is a possibility to select patients with the worst prognosis and treat them more aggressively.

Published
2021

15. Can the first radiofrequency application for ablation of atrial tachycardia be successful in a patient after Fontan correction? With a little bit of luck… yes

Author

Michał Orczykowski, Piotr Hoffman, Łukasz Szumowski, Andrzej Hasiec, Maciej Sterliński, Piotr Zieliński, and Marcin Demkow

Subjects
medicine.medical_specialty, business.industry, media_common.quotation_subject, medicine.medical_treatment, MEDLINE, Ablation, Electrocardiography, Luck, Internal medicine, Cardiology, Catheter Ablation, Tachycardia, Supraventricular, Medicine, Humans, In patient, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Bit (key), Atrial tachycardia, media_common
Published
2021

16. Methods Employed to Assess Left Ventricular Ejection Fraction in Patients Referred for Cardiac Resynchronization Therapy in Poland as Compared to other European Countries. Results from the European Cardiac Resynchronization Therapy Survey II

Author

Maciej Sterliński, Łukasz Szumowski, Damian Łasocha, Krystian Josiak, Kenneth Dickstein, Cecilia Linde, Dariusz Zając, Camilla Normand, and Mateusz Tajstra

Subjects
medicine.medical_specialty, Ejection fraction, business.industry, medicine.medical_treatment, Internal medicine, Cardiac resynchronization therapy, medicine, Cardiology, In patient, business
Published
2019
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17. Positional sleep disordered breathing in patients with arrhythmia. Should we advise our patients to avoid supine position during sleep?

Author

Maria Bilińska, Michał Orczykowski, Rafał Baranowski, Łukasz Szumowski, Kamil Marcinkiewicz, and Katarzyna Kalin

Subjects
Male, medicine.medical_specialty, Supine position, macromolecular substances, 030204 cardiovascular system & hematology, Electrocardiography, 03 medical and health sciences, Sleep Apnea Syndromes, 0302 clinical medicine, Internal medicine, mental disorders, Supine Position, medicine, Humans, Ventricular ectopy, In patient, cardiovascular diseases, 030212 general & internal medicine, business.industry, Atrial fibrillation, medicine.disease, nervous system diseases, respiratory tract diseases, Electrocardiography, Ambulatory, Sleep disordered breathing, Cardiology, Breathing, Female, Sleep (system call), Sleep, Cardiology and Cardiovascular Medicine, business, Holter monitoring
Abstract

Background Sleep disordered breathing [SDB] is a well-known problem in patients with cardiovascular diseases. Around 50% of pts. with SDB present positional sleep disordered breathing [PSDB]. Aims The aim of this study was the investigation of the frequency of PSDB in patients with different forms of arrhythmias. Methods We analyzed the presence of SDB in 53 pts. with diagnosed atrial fibrillation (paroxysmal or persistent), 88 pts. before ablation of ventricular ectopy and 110 pts. that had Holter monitoring due to the symptoms suggesting arrhythmia. Results Finally, we could collect all the data in 243 pts. – 150 men 93 women. AHI 15 in 107 (44%) pts. Moderate sleep disordered breathing was diagnosed in 59 (24%) pts. (AHI 15–30), severe sleep disordered breathing (AHI > 30) was recognized in 48 (20%) pts. In all of the analyzed groups, AHI in supine position was significantly higher than in nonsupine position. PSDB was recorded in 55% of pts. with AHI > 15 and in 29% of pts. (n = 14) with AHI > 30. Percentage of time in supine position was an independent factor related with the presence of at least moderate or severe sleep disordered breathing. Conclusion 1. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. 2. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome. Condensed abstract Sleep disordered breathing SDB is a frequent problem of pts. with cardiovascular diseases. It may influence the prognosis. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome. What is new? - The presence of positional sleep disordered breathing in pts. with arrhythmias is reported. - Positional dependence of the disordered breathing is presented even in pts. with almost normal AHI results.

Published
2019
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18. Comprehensive Heart Failure Care pilot study: starting point and expected developments

Author

Łukasz Szumowski, Adam Witkowski, Adam Kozierkiewicz, Piotr Ponikowski, Jacek Legutko, Tomasz Hryniewiecki, Andrzej Gackowski, Mariusz Gąsior, Jarosław Kaźmierczak, Marcin Gruchała, Radosław Sierpiński, Andrzej Śliwczyński, Maciej Miłkowski, Andrzej Zapaśnik, Izabella Uchmanowicz, Jadwiga Nessler, Przemysław Leszek, Piotr Rozentryt, Ewa Straburzyńska-Migaj, Adam Windak, and Tomasz Grodzicki

Subjects
Heart Failure, medicine.medical_specialty, Point (typography), business.industry, MEDLINE, Pilot Projects, medicine.disease, Heart failure, medicine, Humans, Comprehensive Health Care, Poland, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2019
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19. Distances between transseptal puncture site and anatomical landmarks

Author

Łukasz Szumowski, Michał Orczykowski, Robert Bodalski, Dobromiła Dzwonkowska, Adam Gorlo, Jacek Kuśnierz, Jakub Baran, Paweł Derejko, Andrzej Hasiec, and Aleksander Bardyszewski

Subjects
Adult, Male, Cardiac Catheterization, endocrine system, Adolescent, Femoral vein, Punctures, 030204 cardiovascular system & hematology, Radiography, Interventional, Pulmonary vein, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, immune system diseases, Superior vena cava, Physiology (medical), Atrial Fibrillation, Catheterization, Peripheral, Heart Septum, Humans, Medicine, 030212 general & internal medicine, Coronary sinus, Aged, business.industry, virus diseases, Mean age, Anatomy, Femoral Vein, Middle Aged, Atrial wall, Ostium, Fluoroscopy, Catheter Ablation, Female, Anatomic Landmarks, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Right anterior
Abstract

The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy-guided approach. METHODS AND RESULTS: A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X-ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = -21 ± 7 mm; RAO 53 = -19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = -5 ± 4 mm, RAO 53 = -3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid-RAO projections, was very small. CONCLUSION: The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.

Published
2019
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20. Patients with heart failure and an implanted cardioverter-defibrillator during the coronavirus disease 2019 pandemic: insights from a multicenter registry in Poland

Author

Mateusz, Tajstra, Adam, Wojtaszczyk, Maciej, Sterliński, Ewa, Świerżyńska, Łukasz, Szumowski, Mikołaj, Tomasiuk, Marcin, Grabowski, Łukasz J, Januszkiewicz, Janusz, Romanek, Andrzej, Przybylski, Przemysław, Mitkowski, Aneta, Klotzka, Andrzej, Szafranek, Mariusz, Gąsior, Zbigniew, Kalarus, and Oskar, Kowalski

Subjects
Heart Failure, SARS-CoV-2, COVID-19, Humans, Poland, Registries, Pandemics, Defibrillators, Defibrillators, Implantable
Published
2021

21. Patients with heart failure and an implanted cardioverter-defibrillator during the COVID-19 pandemic: insights from a multicentre registry in Poland

Author

Łukasz Januszkiewicz, Adam Wojtaszczyk, Przemysław Mitkowski, Mariusz Gąsior, Ewa Świerżyńska, Andrzej Przybylski, Marcin Grabowski, Mateusz Tajstra, Zbigniew Kalarus, Aneta Klotzka, Oskar Kowalski, Mikolaj Tomasiuk, Janusz Romanek, Łukasz Szumowski, Andrzej Szafranek, and Maciej Sterliński

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Heart failure, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pandemic, Emergency medicine, medicine, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published
2021
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24. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. 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Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. M., Agarwal, G., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmed, M. B., Akalu, T. Y., Akinyemi, R. O., Akinyemiju, T., Akombi, B., Akunna, C. J., Alahdab, F., Al-Aly, Z., Alam, K., Alam, S., Alam, T., Alanezi, F. M., Alanzi, T. M., Alemu, B. W., Alhabib, K. F., Ali, M., Ali, S., Alicandro, G., Alinia, C., Alipour, V., Alizade, H., Aljunid, S. M., Alla, F., Allebeck, P., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Alonso, J., Altirkawi, K. A., Amini-Rarani, M., Amiri, F., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C. L., Andrei, T., Angus, C., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Antonazzo, I. C., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Ariani, F., Armoon, B., Arnlov, J., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Assmus, M., Atafar, Z., Atnafu, D. D., Atout, M. M. W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. A., Davitoiu, D. V., De Leo, D., Degenhardt, L., Delang, M., Dellavalle, R. P., Demeke, F. M., Demoz, G. T., Demsie, D. G., Denova-Gutierrez, E., Dervenis, N., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dibaji Forooshani, Z. S., Djalalinia, S., Do, H. T., Dokova, K., Dorostkar, F., Doshmangir, L., Driscoll, T. R., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S. I., Elyazar, I. R., Emmons-Bell, S., Erskine, H. E., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A. E., Fanzo, J., Farahmand, M., Fareed, M., Faridnia, R., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Force, L. M., Foroutan, M., Franklin, R. C., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Gallus, S., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B. S., Gebreslassie, A. A. A. A., Geremew, A., Gershberg Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Gill, P. S., Ginindza, T. G. G., Giussani, G., Gnedovskaya, E. V., Goharinezhad, S., Gopalani, S. V., Gorini, G., Goudarzi, H., Goulart, A. C., Greaves, F., Grivna, M., Grosso, G., Gubari, M. I. M., Gugnani, H. C., Guimaraes, R. A., Guled, R. A., Guo, G., Guo, Y., Gupta, R., Gupta, T., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamidi, S., Hammer, M. S., Hankey, G. J., Haririan, H., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hasanpoor, E., Hashi, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Henrikson, H. J., Herbert, M. E., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Holla, R., Hoogar, P., Hosgood, H. D., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Hsieh, V. C. -R., Hu, G., Hu, K., Huda, T. M., Humayun, A., Huynh, C. K., Hwang, B. -F., Iannucci, V. C., Ibitoye, S. E., Ikeda, N., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Inbaraj, L. R., Ippolito, H., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Iso, H., Ivers, R. Q., Iwu, C. C. D., Iwu, C. J., Iyamu, I. O., Jaafari, J., Jacobsen, K. H., Jafari, H., Jafarinia, M., Jahani, M. A., Jakovljevic, M., Jalilian, F., James, S. L., Janjani, H., Javaheri, T., Javidnia, J., Jeemon, P., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Johansson, L., John, O., John-Akinola, Y. O., Johnson, C. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Li, S., Lim, L. -L., Linn, S., Liu, S., Liu, Y., Lo, J., Lopez, A. D., Lopez, J. C. F., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lu, A., Lugo, A., Maddison, E. R., Mahasha, P. W., Mahdavi, M. M., Mahmoudi, M., Majeed, A., Maleki, A., Maleki, S., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manda, A. L., Manguerra, H., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M. A., Mantilla Herrera, A. M., Maravilla, J. C., Marks, A., Martin, R. V., Martini, S., Martins-Melo, F. R., Masaka, A., Masoumi, S. Z., Mathur, M. R., Matsushita, K., Maulik, P. K., Mcalinden, C., Mcgrath, J. J., Mckee, M., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mereke, A., Mereta, S. T., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Miller, T. R., Mills, E. J., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei, R., Mirzaei-Alavijeh, M., Misganaw, A. T., Mithra, P., Moazen, B., Mohammad, D. K., Mohammad, Y., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, A. S., Mohammed, H., Mohammed, J. A., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mooney, M. D., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morawska, L., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mousavi Khaneghah, A., Mueller, U. O., Mukhopadhyay, S., Mullany, E. C., Musa, K. I., Muthupandian, S., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Nagel, G., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Najafi, F., Nangia, V., Nansseu, J. R., Naserbakht, M., Nayak, V. C., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nguyen, M., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F. A., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Orpana, H. M., Ortiz, A., Osarenotor, O., Osei, F. B., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., P A, M., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Parry, C. D. H., Pasovic, M., Pasupula, D. K., Patel, S. K., Pathak, M., Patten, S. B., Patton, G. C., Pazoki Toroudi, H., Peden, A. E., Pennini, A., Pepito, V. C. F., Peprah, E. K., Pereira, D. M., Pesudovs, K., Pham, H. Q., Phillips, M. R., Piccinelli, C., Pilz, T. M., Piradov, M. A., Pirsaheb, M., Plass, D., Polinder, S., Polkinghorne, K. R., Pond, C. D., Postma, M. J., Pourjafar, H., Pourmalek, F., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Raggi, A., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S. B., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, D. C., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. L. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Saeedi Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S. M., Salam, N., Salamati, P., Salem, H., Salem, M. R. R., Salimzadeh, H., Salman, O. M., Salomon, J. A., Samad, Z., Samadi Kafil, H., Sambala, E. Z., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D. F., Santos, I. S., Santos, J. V., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Saxena, S., Schaeffer, L. E., Schiavolin, S., Schlaich, M. P., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Serdar, B., Serre, M. L., Shadid, J., Shafaat, O., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sheikh, A., Sheikhtaheri, A., Shibuya, K., Shield, K. D., Shigematsu, M., Shin, J. I., Shin, M. -J., Shiri, R., Shirkoohi, R., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, J. P., Simpson, K. E., Singh, J. A., Singh, P., Skiadaresi, E., Skou, S. T. S., Skryabin, V. Y., Smith, E. U. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soshnikov, S., Soyiri, I. N., Spencer, C. N., Spotin, A., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stein, C., Stein, D. J., Steiner, C., Stockfelt, L., Stokes, M. A., Straif, K., Stubbs, J. L., Sufiyan, M. B., Suleria, H. A. R., Suliankatchi Abdulkader, R., Sulo, G., Sultan, I., Szumowski, Tabares-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taherkhani, A., Tajdini, M., Takahashi, K., Takala, J. S., Tamiru, A. T., Taveira, N., Tehrani-Banihashemi, A., Temsah, M. -H., Tesema, G. A., Tessema, Z. T., Thurston, G. D., Titova, M. V., Tohidinik, H. R., Tonelli, M., Topor-Madry, R., Topouzis, F., Torre, A. E., Touvier, M., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Tsatsakis, A., Tudor Car, L., Tyrovolas, S., Uddin, R., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Vacante, M., Valdez, P. R., van Donkelaar, A., Vasankari, T. J., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vos, T., Vukovic, R., Waheed, Y., Wallin, M. 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S., Lacey, B, Sartorius, B, Abbafati, C, Abbas, K, Abbasi-Kangevari, M, Abd-Allah, F, Abdelalim, A, Abdollahi, M, Abdollahpour, I, Abegaz, K, Abolhassani, H, Aboyans, V, Abreu, L, Abrigo, M, Abualhasan, A, Abu-Raddad, L, Abushouk, A, Adabi, M, Adekanmbi, V, Adeoye, A, Adetokunboh, O, Adham, D, Advani, S, Afshin, A, Agarwal, G, Aghamir, S, Agrawal, A, Ahmad, T, Ahmadi, K, Ahmadi, M, Ahmadieh, H, Ahmed, M, Akalu, T, Akinyemi, R, Akinyemiju, T, Akombi, B, Akunna, C, Alahdab, F, Al-Aly, Z, Alam, K, Alam, S, Alam, T, Alanezi, F, Alanzi, T, Alemu, B, Alhabib, K, Ali, M, Ali, S, Alicandro, G, Alinia, C, Alipour, V, Alizade, H, Aljunid, S, Alla, F, Allebeck, P, Almasi-Hashiani, A, Al-Mekhlafi, H, Alonso, J, Altirkawi, K, Amini-Rarani, M, Amiri, F, Amugsi, D, Ancuceanu, R, Anderlini, D, Anderson, J, Andrei, C, Andrei, T, Angus, C, Anjomshoa, M, Ansari, F, Ansari-Moghaddam, A, Antonazzo, I, Antonio, C, Antony, C, Antriyandarti, E, Anvari, D, Anwer, R, Appiah, S, Arabloo, J, Arab-Zozani, M, Aravkin, A, Ariani, F, Armoon, B, Arnlov, J, Arzani, A, Asadi-Aliabadi, M, Asadi-Pooya, A, Ashbaugh, C, Assmus, M, Atafar, Z, Atnafu, D, Atout, M, Ausloos, F, Ausloos, M, Ayala Quintanilla, B, Ayano, G, Ayanore, M, Azari, S, Azarian, G, Azene, Z, Badawi, A, Badiye, A, Bahrami, M, Bakhshaei, M, Bakhtiari, A, Bakkannavar, S, Baldasseroni, A, Ball, K, Ballew, S, Balzi, D, Banach, M, Banerjee, S, Bante, A, Baraki, A, Barker-Collo, S, Barnighausen, T, Barrero, L, Barthelemy, C, Barua, L, Basu, S, Baune, B, Bayati, M, Becker, J, Bedi, N, Beghi, E, Bejot, Y, Bell, M, Bennitt, F, Bensenor, I, Berhe, K, Berman, A, Bhagavathula, A, Bhageerathy, R, Bhala, N, Bhandari, D, Bhattacharyya, K, Bhutta, Z, Bijani, A, Bikbov, B, Bin Sayeed, M, Biondi, A, Birihane, B, Bisignano, C, Biswas, R, Bitew, H, Bohlouli, S, Bohluli, M, Boon-Dooley, A, Borges, G, Borzi, A, Borzouei, S, Bosetti, C, Boufous, S, Braithwaite, D, Brauer, M, Breitborde, N, Breitner, S, Brenner, H, Briant, P, Briko, A, Briko, N, Britton, G, Bryazka, D, Bumgarner, B, Burkart, K, Burnett, R, Burugina Nagaraja, S, Butt, Z, Caetano Dos Santos, F, Cahill, L, Camera, L, Campos-Nonato, I, Cardenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castaneda-Orjuela, C, Castelpietra, G, Castro, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, K, Charlson, F, Chattu, V, Chaturvedi, S, Cherbuin, N, Chimed-Ochir, O, Cho, D, Choi, J, Christensen, H, Chu, D, Chung, M, Chung, S, Cicuttini, F, Ciobanu, L, Cirillo, M, Classen, T, Cohen, A, Compton, K, Cooper, O, Costa, V, Cousin, E, Cowden, R, Cross, D, Cruz, J, Dahlawi, S, Damasceno, A, Damiani, G, Dandona, L, Dandona, R, Dangel, W, Danielsson, A, Dargan, P, Darwesh, A, Daryani, A, Das, J, Das Gupta, R, das Neves, J, Davila-Cervantes, C, Davitoiu, D, De Leo, D, Degenhardt, L, Delang, M, Dellavalle, R, Demeke, F, Demoz, G, Demsie, D, Denova-Gutierrez, E, Dervenis, N, Dhungana, G, Dianatinasab, M, Dias da Silva, D, Diaz, D, Dibaji Forooshani, Z, Djalalinia, S, Do, H, Dokova, K, Dorostkar, F, Doshmangir, L, Driscoll, T, Duncan, B, Duraes, A, Eagan, A, Edvardsson, D, El Nahas, N, El Sayed, I, El Tantawi, M, Elbarazi, I, Elgendy, I, El-Jaafary, S, Elyazar, I, Emmons-Bell, S, Erskine, H, Eskandarieh, S, Esmaeilnejad, S, Esteghamati, A, Estep, K, Etemadi, A, Etisso, A, Fanzo, J, Farahmand, M, Fareed, M, Faridnia, R, Farioli, A, Faro, A, Faruque, M, Farzadfar, F, Fattahi, N, Fazlzadeh, M, Feigin, V, Feldman, R, Fereshtehnejad, S, Fernandes, E, Ferrara, G, Ferrari, A, Ferreira, M, Filip, I, Fischer, F, Fisher, J, Flor, L, Foigt, N, Folayan, M, Fomenkov, A, Force, L, Foroutan, M, Franklin, R, Freitas, M, Fu, W, Fukumoto, T, Furtado, J, Gad, M, Gakidou, E, Gallus, S, Garcia-Basteiro, A, Gardner, W, Geberemariyam, B, Ayalew Gebreslassie, A, Geremew, A, Gershberg Hayoon, A, Gething, P, Ghadimi, M, Ghadiri, K, Ghaffarifar, F, Ghafourifard, M, Ghamari, F, Ghashghaee, A, Ghiasvand, H, Ghith, N, Gholamian, A, Ghosh, R, Gill, P, Ginindza, T, Giussani, G, Gnedovskaya, E, Goharinezhad, S, Gopalani, S, Gorini, G, Goudarzi, H, Goulart, A, Greaves, F, Grivna, M, Grosso, G, Gubari, M, Gugnani, H, Guimaraes, R, Guled, R, Guo, G, Guo, Y, Gupta, R, Gupta, T, Haddock, B, Hafezi-Nejad, N, Hafiz, A, Haj-Mirzaian, A, Hall, B, Halvaei, I, Hamadeh, R, Hamidi, S, Hammer, M, Hankey, G, Haririan, H, Haro, J, Hasaballah, A, Hasan, M, Hasanpoor, E, Hashi, A, Hassanipour, S, Hassankhani, H, Havmoeller, R, Hay, S, Hayat, K, Heidari, G, Heidari-Soureshjani, R, Henrikson, H, Herbert, M, Herteliu, C, Heydarpour, F, Hird, T, Hoek, H, Holla, R, Hoogar, P, Hosgood, H, Hossain, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Hsairi, M, Hsieh, V, Hu, G, Hu, K, Huda, T, Humayun, A, Huynh, C, Hwang, B, Iannucci, V, Ibitoye, S, Ikeda, N, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Inbaraj, L, Ippolito, H, Iqbal, U, Irvani, S, Irvine, C, Islam, M, Islam, S, Iso, H, Ivers, R, Iwu, C, Iyamu, I, Jaafari, J, Jacobsen, K, Jafari, H, Jafarinia, M, Jahani, M, Jakovljevic, M, Jalilian, F, James, S, Janjani, H, Javaheri, T, Javidnia, J, Jeemon, P, Jenabi, E, Jha, R, Jha, V, Ji, J, Johansson, L, John, O, John-Akinola, Y, Johnson, C, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kabir, A, Kabir, Z, Kalani, H, Kalani, R, Kalankesh, L, Kalhor, R, Kanchan, T, Kapoor, N, Matin, B, Karch, A, Karim, M, Kassa, G, Katikireddi, S, Kayode, G, Kazemi Karyani, A, Keiyoro, P, Keller, C, Kemmer, L, Kendrick, P, Khalid, N, Khammarnia, M, Khan, E, Khan, M, Khatab, K, Khater, M, Khatib, M, Khayamzadeh, M, Khazaei, S, Kieling, C, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kivimaki, M, Knibbs, L, Knudsen, A, Kocarnik, J, Kochhar, S, Kopec, J, Korshunov, V, Koul, P, Koyanagi, A, Kraemer, M, Krishan, K, Krohn, K, Kromhout, H, Kuate Defo, B, Kumar, G, Kumar, V, Kurmi, O, Kusuma, D, La Vecchia, C, Lal, D, Lalloo, R, Lallukka, T, Lami, F, Landires, I, Lang, J, Langan, S, Larsson, A, Lasrado, S, Lauriola, P, Lazarus, J, Lee, P, Lee, S, Legrand, K, Leigh, J, Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Li, S, Lim, L, Linn, S, Liu, S, Liu, Y, Lo, J, Lopez, A, Lopez, J, Lopukhov, P, Lorkowski, S, Lotufo, P, Lu, A, Lugo, A, Maddison, E, Mahasha, P, Mahdavi, M, Mahmoudi, M, Majeed, A, Maleki, A, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manda, A, Manguerra, H, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martin, R, Martini, S, Martins-Melo, F, Masaka, A, Masoumi, S, Mathur, M, Matsushita, K, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Memish, Z, Mendoza, W, Menezes, R, Mengesha, E, Mereke, A, Mereta, S, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Miller, T, Mills, E, Mini, G, Miri, M, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei, R, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020
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25. Implantable cardiac defibrillator events in patients with arrhythmogenic right ventricular cardiomyopathy

Author

Łukasz Szumowski, Alicja Cicha-Mikołajczyk, Elżbieta Katarzyna Biernacka, Piotr Hoffman, Olgierd Woźniak, Karolina Borowiec, Marek Konka, Krzysztof Bernard Poślednik, and Andrzej Przybylski

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Population, Ventricular tachycardia, Right ventricular cardiomyopathy, Sudden cardiac death, Internal medicine, medicine, Humans, education, Arrhythmogenic Right Ventricular Dysplasia, Heart transplantation, education.field_of_study, business.industry, medicine.disease, Arrhythmogenic right ventricular dysplasia, Defibrillators, Implantable, Death, Sudden, Cardiac, Ventricular fibrillation, Cardiology, Antitachycardia Pacing, Tachycardia, Ventricular, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

ObjectiveArrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of sudden cardiac death. Optimal risk stratification is still under debate. The main purpose of this long-term, single-centre observation was to analyse predictors of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) interventions in the population of patients with ARVC with a high risk of life-threatening arrhythmias.MethodsThe study comprised 65 adult patients (median age 40 years, 48 men) with a definite diagnosis of ARVC who received ICD over a time span of 20 years in primary (40%) or secondary (60%) prevention of sudden cardiac death. The study endpoints were first appropriate and inappropriate ICD interventions (shock or antitachycardia pacing) after device implantation.ResultsDuring a median follow-up of 7.75 years after ICD implantation, nine patients died and six individuals underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2%) and inappropriate ICD interventions in 18 patients (27.7%). Multivariable analysis using cause-specific hazard model identified three predictors of appropriate ICD interventions: right ventricle dysfunction (cause-specific HR 2.85, 95% CI 1.56 to 5.21, pConclusionsRight ventricle dysfunction, age

Published
2020

26. Dynamics of the coronavirus disease 2019 outbreak in Poland: an epidemiological analysis of the first 2 months of the epidemic

Author

Filip, Raciborski, Jarosław, Pinkas, Mateusz, Jankowski, Radosław, Sierpiński, Wojciech S, Zgliczyński, Łukasz, Szumowski, Kamil, Rakocy, Waldemar, Wierzba, and Mariusz, Gujski

Subjects
Adult, Male, Adolescent, Clinical Laboratory Techniques, SARS-CoV-2, Pneumonia, Viral, COVID-19, Middle Aged, Real-Time Polymerase Chain Reaction, Health Services Accessibility, Betacoronavirus, Young Adult, Age Distribution, COVID-19 Testing, Humans, Female, Poland, Sex Distribution, Coronavirus Infections, Pandemics, Aged
Abstract

Coronavirus disease 2019 (COVID‑19) is an infectious disease caused by the novel severe acute respiratory syndrome coronavirus 2.Our aim was to present an epidemiological analysis of the first 2 months (March and April 2020) of the COVID‑19 epidemic in Poland.This analysis was based on data from epidemiological reports collected between March 4 and April 30, 2020, by the Chief Sanitary Inspectorate. These epidemiological reports include data on sociodemographic characteristics of new laboratory‑confirmed COVID 19 cases, the number of COVID‑19-related deaths, the number of recovered COVID-19 patients as well as the number of laboratory tests performed.From March 4 to April 30, 2020, a total of 12 877 laboratory‑confirmed COVID 19 cases were registered in Poland (55.7% women; mean [SD] age, 50.6 [20.5] years). The RT‑ PCR test was performed in 338 000 patients. The notification rate for COVID‑19 was 33.2 per 100 000 inhabitants. One third of laboratory‑confirmed COVID 19 cases were among quarantined persons, 26.1% were related to the healthcare system (hospital or clinic), and 13.3% occurred in nursing homes. As of April 30, 2020, 644 COVID‑19-related deaths were registered in Poland (46.5% women). The death rate for the whole country was 1.7 per 100 000 inhabitants.Our data showed higher notification rate for COVID‑19 among women than men, but men were more likely to die from COVID‑19. The notification rate for COVID-19 in Poland among women aged 45 to 54 years was 2‑fold higher than among men.

Published
2020

27. Gender differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among 1,942 non-hospitalized patients with COVID-19

Author

Mariusz Gujski, Mateusz Jankowski, Łukasz Szumowski, Radosław Sierpiński, Waldemar Wierzba, Wojciech Zgliczyński, and Jarosław Pinkas

Subjects
Response rate (survey), medicine.medical_specialty, Communicable disease, business.industry, Cross-sectional study, 030206 dentistry, medicine.disease, Comorbidity, 03 medical and health sciences, Diarrhea, Pneumonia, 0302 clinical medicine, Taste disorder, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, 030212 general & internal medicine, medicine.symptom, business
Abstract

INTRODUCTION: The coronavirus disease 2019 (COVID 19) is a communicable disease caused by a novel coronavirus. OBJECTIVES: This study aimed to assess self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders in nonhospitalized patients with COVID­19 in Poland. PATIENTS AND METHODS: This cross­sectional survey was conducted between April 17 and 18, 2020, in 4516 nonhospitalized patients with COVID­19 in Poland. The questionnaire included 8 questions related to the health status, symptoms of COVID­19, comorbidities, and smoking status. RESULTS: Completed questionnaires were obtained from 1942 patients with COVID­19 with a response rate of 43%. The median age of the respondents was 50 years; 60.2% were women. Among nonhospitalized patients with COVID­19, 21.3% had hypertension, 4.5% had diabetes, and 3.1% had a chronic respiratory disease. Regular tobacco use was declared by 11.2% of patients with COVID­19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID­19 reported lack of appetite and 24.2% reported diarrhea. Among 1942 interviewed patients, 54.2% reported at least 1 olfactory or taste disorder and 42.5% reported both alterations. Self­reported olfactory and taste disorders were 49.2% and 47.5%, respectively. Self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders during COVID­19 was significantly higher (P

Published
2020
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28. Public Health Interventions to Mitigate Early Spread of SARS-CoV-2 in Poland

Author

Jarosław Pinkas, Łukasz Szumowski, Mariusz Gujski, Aleksandra Lusawa, Waldemar Wierzba, Filip Raciborski, Mateusz Jankowski, and Wojciech Zgliczyński

Subjects
Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Public health interventions, 030204 cardiovascular system & hematology, law.invention, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, law, Political science, Quarantine, Pandemic, Humans, Epidemics, Socioeconomics, Pandemics, Potential impact, SARS-CoV-2, Health Policy, Social distance, COVID-19, Outbreak, General Medicine, Coronavirus, Special Reports, 030220 oncology & carcinogenesis, Communicable Disease Control, Poland, Emergencies, Coronavirus Infections
Abstract

This study aimed (1) to present public health interventions to mitigate the early spread of SARS-CoV-2 implemented in Poland between January 9 and March 29, 2020, and (2) to analyze the potential impact of these regulations on the early phase of the COVID-19 outbreak in Poland. All legal regulations published in the Journal of Laws between January 9 and March 29, 2020, were analyzed. Out of 406 legal regulations identified, 56 were related to the COVID-19 outbreak. Moreover, the official announcements published on the governmental websites dedicated to the coronavirus and health issues were analyzed. On March 4, Poland reported the first laboratory-confirmed COVID-19 case. On March 9, Poland introduced border sanitary control. Six days after the first laboratory-confirmed COVID-19 case, all mass events in Poland were banned. All schools and universities were closed 8 days after the first COVID-19 case. All gastronomic facilities and sport and entertainment services were limited starting on March 14. Eleven days after the first COVID-19 case, controls at all Polish borders were introduced, and a ban on entry into Poland by foreigners (with some exemptions) was implemented. Starting on March 15, all citizens returning from abroad had to undergo compulsory 14 days self-quarantine. On March 20, a state of epidemic was announced, which resulted in new social distancing measures starting on March 25. In Poland, compared to other European countries, far-reaching solutions were implemented relatively early to reduce the spread of infection.

Published
2020
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29. Ablation of atrial tachyarrhythmias late after surgical correction of tetralogy of Fallot: long-term follow-up

Author

Katarzyna Kodziszewska, Krystyna Guzek, Agnieszka Fil, Maria Bilińska, Michał Orczykowski, Łukasz Szumowski, Kamil Marcinkiewicz, Karolina Borowiec, Elżbieta Katarzyna Biernacka, Piotr Urbanek, Paweł Derejko, Piotr Hoffman, Olgierd Woźniak, Aneta Fronczak, Grzegorz Warmiński, and Robert Bodalski

Subjects
Adult, Male, 0301 basic medicine, Tachycardia, medicine.medical_specialty, Radiofrequency ablation, Long term follow up, medicine.medical_treatment, law.invention, Pulmonary vein, Young Adult, 03 medical and health sciences, Recurrence, law, Internal medicine, Humans, Medicine, cardiovascular diseases, Cardiac Surgical Procedures, Aged, Tetralogy of Fallot, business.industry, Middle Aged, Surgical correction, medicine.disease, Ablation, Treatment Outcome, 030104 developmental biology, Atrial Flutter, Catheter Ablation, cardiovascular system, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrial flutter, Follow-Up Studies
Abstract

Background: After the surgical correction of tetralogy of Fallot, surgical scars and natural obstacles form pathways capable of supporting an atrial tachyarrhythmia (AT). Radiofrequency (RF) ablation is effective, although the few studies published on this topic had relatively short follow-up periods. Aim: The aims of the study were to evaluate the acute and long-term effects of RF ablation of AT and examine the charac­teristics of arrhythmia recurrence. Methods: Tetralogy of Fallot patients (n = 16, age 44.7 ± 10.7 years) referred for ablation of ATs, appearing 25.7 ± 9.6 years after repair, were studied. Results: Twenty-five ATs were ablated, including 16 cavo-tricuspid isthmus atrial flutters (CTI-AFLs) and nine intraatrial reentrant tachycardia (IART). In one patient with paroxysmal atrial fibrillation (PAF), pulmonary vein isolation was also performed. Ten patients had permanent, and six had paroxysmal arrhythmia prior to the first ablation. Four patients had PAF. Regardless of the type of first ablated arrhythmia, all 16 patients required CTI-AFL ablation. The effectiveness of the first RF ablation reached 88%. The acute efficacy of RF ablation was 100% for CTI-AFL and 78% for IART. Long-term follow-up was possible in 15 out of 16 patients (mean follow-up 68.8 ± 36.6 months). Four patients were free of sustained arrhythmia, nine (60%) had AF. After the last RF ablation, an episode suggestive of CTI-AFL/IART was documented only in one patient. Conclusions: Ablation of CTI-AFL/IART in tetralogy of Fallot patients is safe and effective. AF was observed in most patients during the long-term follow-up. Regardless of the type of the first ablated arrhythmia, all patients required CTI-AFL ablation.

Published
2018
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30. Risk factors of atrial fibrillation recurrence despite successful radiofrequency ablation of accessory pathway: At 11 years of follow-up

Author

Maciej Sterliński, Piotr Urbanek, Łukasz Szumowski, Maciej Dąbrowski, Robert Bodalski, Maria Bilińska, Michał Orczykowski, Joanna Zakrzewska-Koperska, Paweł Tyczyński, Grzegorz Warmiński, Damian Łasocha, Małgorzata Łodyga, Paweł Derejko, Rafał Baranowski, Artur Oręziak, and Łukasz Mazurkiewicz

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Adolescent, Radiofrequency ablation, medicine.medical_treatment, Accessory pathway, 030204 cardiovascular system & hematology, law.invention, Electrocardiography, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Heart Conduction System, Recurrence, Risk Factors, law, Internal medicine, Atrial Fibrillation, medicine, Humans, Risk factor, Atrial tachycardia, Aged, Retrospective Studies, Univariate analysis, business.industry, Incidence, Atrial fibrillation, General Medicine, Middle Aged, medicine.disease, Ablation, Surgery, Treatment Outcome, 030228 respiratory system, Catheter Ablation, Cardiology, Female, Poland, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Forecasting
Abstract

Background: Previous reports on patients with radiofrequency catheter ablation (RFCA) of accessory pathway (AP) and atrial fibrillation (AF) include only short follow-up periods. The aim of this study was to analyze predictors of recurrence of AF in patients after successful RFCA of APs over long term follow-up periods. Methods: Of the 1,007 patients who underwent non-pharmacological treatment of APs (between the years 1993–2008), data of 100 consecutive patients were retrospectively analyzed (75 men, mean age 43.6 ± 14.7), with the longest period of follow-up (mean 11.3 ± 3.5 years) after successful RFCA of AP. In Group 1, there were 72 patients (54 men, mean age 40.66 ± 13.85 years) without documented episodes of AF after RFCA of AP. Group 2 consisted of 28 patients (21 men, mean age 50.79 ± 14.49 years) with AF episodes despite successful elimination of AP. Results: In univariate analysis, patients from Group 1 were significantly younger at the time of ablation than patients from Group 2 (40.66 ± 13.85 vs. 50.79 ± 14.49 years; p = 0.002), had shorter history of AF episodes (4.11 ± 4.07 vs. 8.25 ± 7.50 years; p = 0.024) and had less frequently documented atrial tachycardia (AT) prior to ablation (3.39 vs. 20.00%; p = 0.022). In multivariate analysis, the history of AF in years (p = 0.043), was an independent risk factor for AF recurrences. Conclusions: Older patient age, longer history of AF and AT prior to RFCA of APs identified a subgroup of patients who required additional treatment. In the multivariate analysis, the history of AF in years (p = 0.043) was a risk factor for AF recurrence.

Published
2017
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31. Socioeconomic aspects of arrhythmias treatment in Poland in comparison with other EU countries- systematic report

Author

Łukasz Szumowski, Tomasz Hryniewiecki, Radosław Sierpiński, Andrzej Śliwczyński, Jan Gryglewicz, Jakub Gierczyński, Małgorzata Gałązka Sobotka, Piotr Hoffman, and Jarosław Kaźmierczak

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine, Catheter ablation, Atrial fibrillation, business, Intensive care medicine, medicine.disease, Socioeconomic status, Eu countries
Published
2017
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32. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. Huda, Fakher Rahim, Dara K. Mohammad, Yingxi Zhao, Ruxandra Irina Negoi, Vinod C. Nayak, Reinhard Busse, Andrew T. Leever, Muhammad Aziz Rahman, Kathryn Mei Ming Lau, Stefania Mondello, Vivian Chia-Rong Hsieh, Kris J. Krohn, Reza Rawassizadeh, Vishnu Renjith, Jianing Ma, Moses K. Muriithi, Mark G. Shrime, Mayowa O. Owolabi, Nobuyuki Horita, Seyed Hossein Yahyazadeh Jabbari, Daniel Y. Cho, Miloje Savic, Moslem Soofi, Iqbal R. F. Elyazar, Freweini Gebrearegay G. Tela, Jonathan F. Mosser, Palash Chandra Banik, Andre Rodrigues Duraes, Yuan-Pang Wang, Natalie C. Galles, Rashid Abdi Guled, Abdallah M. Samy, Hadi Pourjafar, Roman Topor-Madry, Ayesha Humayun, Leila Zaki, Nuworza Kugbey, Maryam Khayamzadeh, Naznin Hossain, Jiregna Darega Gela, Jordi Alonso, Ruth W Kimokoti, A. A. Fomenkov, Jalal Arabloo, Aletta E. Schutte, Biruk Wogayehu Taddele, Teklehaimanot Gereziher Haile, Diego Augusto Santos Silva, Seyed Mohammad Kazem Aghamir, Maciej Banach, Deanna Anderlini, Moses J. Bockarie, Saleem Muhammad Rana, Randah R. Hamadeh, Farhad Islami, Olalekan A. Uthman, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Kairat Davletov, Soraya Seedat, Alan D. Lopez, Masoud Behzadifar, Benjamin B. Massenburg, Santosh Varughese, Ingan Ukur Tarigan, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Caleb Mackay Salpeter Irvine, Mojgan Gitimoghaddam, G Anil Kumar, Rasmus J. Havmoeller, Hiroyasu Iso, Atte Meretoja, Yasir Waheed, João M. Furtado, Christian Razo, Neeti Kapoor, Mowafa Househ, Rajaa Al-Raddadi, Mohammad Khammarnia, Santi Martini, Feng Sha, Marco Vacante, Jacek A. Kopec, Hunduma Amensisa Bojia, Jacob Olusegun Olusanya, Kate E. LeGrand, Nikolay Ivanovich Briko, Robert S. Bernstein, Arun Balachandran, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Leake G. Gebremeskel, Smita Pakhale, Ejaz Ahmad Khan, Daniel Cury Ribeiro, Yousef Mohammad, Bernhard T. Baune, Azeem Majeed, Luis Camera, Mohammad Ali Jahani, Hasan Yusefzadeh, Rahman Shiri, Massimo Cirillo, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Paolo Lauriola, Irfan Ullah, Aruna M Kamath, Maryam Mirzaei, Zabihollah Yousefi, Iman El Sayed, Mohammad Farahmand, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Felix Akpojene Ogbo, Megan Knight, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Iván Landires, Robert G. Weintraub, Chukwudi A Nnaji, Lauren E. Schaeffer, Paulo A. Lotufo, Mehdi Naderi, Tomislav Mestrovic, André Faro, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Vladimir Andreevich Korshunov, Birhanu Geta Meharie, Mihajlo Jakovljevic, Abdiwahab Hashi, Olatunji O. Adetokunboh, Dejana Braithwaite, Sergio I. Prada, Bárbara Niegia Garcia de Goulart, Reza Pourmirza Kalhori, Jee-Young Jasmine Choi, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Paul S. F. Yip, Mehdi Mirzaei-Alavijeh, Gebremariam Woldu, Rashmi Gupta, Onome Bright Oghenetega, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Mehdi Hosseinzadeh, Marcos Roberto Tovani-Palone, K M Shivakumar, Alireza Ansari-Moghaddam, Archith Boloor, Aidin Abedi, Binyam Minuye Birihane, Mohammad Ali Mansournia, Nihad A. Almasri, Simachew Animen Bante, Carlo Eduardo Medina-Solís, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Antonio Biondi, Valentin Yurievich Skryabin, Srinivasa Vittal Katikireddi, Sarika Chaturvedi, Francesco Saverio Violante, Abhay Gaidhane, George A. Mensah, Naohiro Yonemoto, Ahmad Ghashghaee, Ebrahim Babaee, Saman Esmaeilnejad, Sharath Burugina Nagaraja, Avina Vongpradith, Javad Nazari, Amir Khater, Michael K. Hole, Ben Lacey, Razique Anwer, Łukasz Szumowski, Ai Koyanagi, Rajesh Sagar, Ali Rajabpour-Sanati, Seyed M Karimi, Yordanos Gizachew Yeshitila, Mona Pathak, Nithin Kumar, Masoud Foroutan, Mehdi Fazlzadeh, Anusha Ganapati Bhat, Abbas Mosapour, Kebede Deribe, Nermin Ghith, Vaman Kulkarni, Sanjay Zodpey, Asadollah Gholamian, Mohammed Shannawaz, Nancy Fullman, Benn Sartorius, Giulio Castelpietra, Ghulam Mustafa, Silvia Schiavolin, Nelson Alvis-Guzman, Jeffrey D. Stanaway, Rafael Lozano, Christopher J L Murray, Guoqing Hu, Andrew M. Briggs, Ashish Badiye, Yousef Khader, Masoud Moghadaszadeh, Rahmatollah Moradzadeh, Valery L. Feigin, Claudia I. Mastrogiacomo, Emma Smith, Yasser Vasseghian, Saeed Amini, Asif Hanif, Achala Upendra Jayatilleke, Maryam Adabi, Sarah Wulf Hanson, Bhaskar Thakur, Ravi Mehrotra, Virginia Núñez-Samudio, Lalit Dandona, Segun Emmanuel Ibitoye, Simon I. Hay, Kiirithio N. Ngari, Obinna Onwujekwe, Deborah Carvalho Malta, Lorenzo Monasta, Neda Kianipour, Khurshid Alam, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Khalid A Altirkawi, Jaimie Adelson, Hamed Zandian, Frank Tanser, Dharmesh Kumar Lal, John Everett Mumford, Morteza Oladnabi, Telma Zahirian Moghadam, Rodrigo Sarmiento-Suárez, Masoud Moradi, Maseer Khan, Mohammad Ali Sahraian, Amy E. Peden, Dhirendra N Sinha, Shanshan Li, Shailesh Advani, Behshad Naghshtabrizi, Matilde Leonardi, Lope H Barrero, Nicholas Steel, Dinh-Toi Chu, Claudio Alberto Dávila-Cervantes, Pushpendra Singh, Adrian Otoiu, Fabrizio Tediosi, Yonas Getaye Tefera, Pawan Faris, George C. Patton, Christopher Troeger, Mohammed Madadin, Jeffrey V. Lazarus, Paul H. Lee, Mohammad Amin Bahrami, Wondimeneh Shibabaw Shiferaw, Emmanuel Wandera Okunga, Biniyam Sahiledengle Geberemariyam, Samer Hamidi, Young-Ho Khang, Rufus Akinyemi, Farhad Jadidi-Niaragh, Godfrey Mutashambara Rwegerera, Naser Mohammad Gholi Mezerji, Rupak Desai, Eduardo Bernabé, Jamal A. Yearwood, Nima Rezaei, Emerito Jose A. Faraon, Vasily Vlassov, Stanislav S. Otstavnov, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Mukhammad David Naimzada, Tahereh Javaheri, Tamer H. Farag, Paolo Cortesi, Gbenga A. Kayode, Lucas Guimarães Abreu, Manu Raj Mathur, Getie Lake Aynalem, Narayanaswamy Venketasubramanian, Doris V.V. Ortega-Altamirano, Giorgia Giussani, Liliana G Ciobanu, Suraj Bhattarai, Basema Saddik, Mustafa Z. Younis, Ensiyeh Jenabi, Ira Martopullo, Mohamed M. Gad, Kanyin L. Ong, Addisu Melese, Fotis Topouzis, Hanne Christensen, In-Hwan Oh, Arash Sarveazad, Shuhei Nomura, Peter Memiah, Sergej M. Ostojic, Santosh Kumar Tadakamadla, Dinesh Bhandari, Ahmed Omar Bali, Farahnaz Joukar, Arielle Wilder Eagan, Emma Elizabeth Spurlock, Ferrán Catalá-López, Caroline Stein, Jonathan M. Kocarnik, Stephen S Lim, Siamak Sabour, Kelly Compton, Shoaib Hassan, Rannveig Sigurvinsdottir, Claudiu Herteliu, Aso Mohammad Darwesh, Muluken Altaye Ayza, Angela Y. Chang, Leila R Kalankesh, Rafael Alves Guimarães, Abdollah Mohammadian-Hafshejani, Lal B. Rawal, Soewarta Kosen, Degena Bahrey Tadesse, Theo Vos, Paula Moraga, Soheil Hassanipour, Abdelrahman Ibrahim Abushouk, Oladimeji Adebayo, Mikk Jürisson, Tuomo J. Meretoja, Ireneous N. Soyiri, Carlo La Vecchia, Khalil Eskandari, Aziz Sheikh, Jagdish Khubchandani, James Leigh, Morteza Arab-Zozani, Sheikh Mohammed Shariful Islam, Stefan Kohler, Olayinka Stephen Ilesanmi, Kazumasa Yamagishi, Michele Romoli, Jasvinder A. Singh, Neeraj Bedi, Ivo Iavicoli, Alyssa Pennini, Subas Neupane, Emmanuel Peprah, Sojib Bin Zaman, Marwa Rashad Salem, Mohammed Ibrahim Mohialdeen Gubari, Ramesh Holla, Bayisa Abdissa Baye, Robert Ancuceanu, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Ettore Beghi, Quique Bassat, B Reshmi, Masood Ali Shaikh, Ionut Negoi, Peter Azzopardi, Florian Fischer, Kerem Shuval, Sorin Hostiuc, Hmwe H Kyu, Ver Bilano, Siddhesh Zadey, Davide Rasella, Vahid Alipour, Sowmya J. Rao, Radoslaw Sierpinski, Irina Filip, Michelle L. Bell, Malke Asaad, Ravensara S. Travillian, Christopher R. Cederroth, Rafael Tabarés-Seisdedos, Ashkan Afshin, Saqib Ali, Mahalaqua Nazli Khatib, Saad M.A. Dahlawi, Hedayat Abbastabar, Zahid A Butt, Sagun Paudel, Vahid Rashedi, B. Suresh Kumar Shetty, Thomas R. Hird, Shokofeh Maleki, Atif Amin Baig, Reza Heidari-Soureshjani, Shaun Wen Huey Lee, Jorge R. Ledesma, Ai-Min Wu, Fablina Sharara, Zemenu Tadesse Tessema, Ratilal Lalloo, Rohollah Kalhor, Rosario Cárdenas, Amir Radfar, Salime Goharinezhad, Fereshteh Mehri, Katarzyna Kissimova-Skarbek, Spencer A. Pease, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Darshan B B, Mariya Vladimirovna Titova, Dickson A. Amugsi, Lee Ling Lim, Agegnehu Bante, Charles D.A. Wolfe, Majid A Almadi, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Tauseef Ahmad, Platon D. Lopukhov, Takahiro Tabuchi, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Ritesh G. Menezes, Giovanni Damiani, Delia Hendrie, Mostafa Amini-Rarani, Sanjay Basu, Mohammad Hossein Bakhshaei, Gholamreza Roshandel, Borhan Mansouri, Enrico Rubagotti, Anurag Agrawal, Alireza Esteghamati, Paramjit Gill, Graeme J. Hankey, Mikhail Sergeevich Zastrozhin, Nima Hafezi-Nejad, Bruce Bartholow Duncan, Silvano Gallus, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Giulia Carreras, Fariba Dorostkar, Pietro Ferrara, Andrea Farioli, Christoph Nowak, Ahmed I. Hasaballah, Vijay Kumar Chattu, Bolajoko O. Olusanya, Perminder S. Sachdev, Era Upadhyay, Tommi Vasankari, Susan M Sawyer, Adnan Kisa, Farshad Pourmalek, Kiomars Sharafi, Golnaz Heidari, Mohammad Abdollahi, Georges Nguefack-Tsague, Sajid Hameed, Sanni Yaya, Bach Xuan Tran, Ole Frithjof Norheim, Robert Kaba Alhassan, Morenike Oluwatoyin Folayan, Ismail Tareque, Phetole Walter Mahasha, Kewal Krishan, Soraya Siabani, Aleksandr Y. Aravkin, Helena Ullyartha Pangaribuan, Maryam Zamanian, Joshua A. Salomon, Bianca S. Zlavog, Vinay Nangia, Falk Schwendicke, Takeshi Fukumoto, Hung Chak Ho, Jordan Weiss, Maha Atout, Tariku Tesfaye Bekuma, Efat Mohamadi, Nikolaos Dervenis, Joan B. 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Peng, Zhu, Cong, Ziapour, Arash, Zlavog, Bianca S, Zodpey, Sanjay, Murray, Christopher J L, Lacey, B, Sartorius, B, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Lozano, R, Fullman, N, Mumford, J, Knight, M, Barthelemy, C, Abbafati, C, Abbastabar, H, Abd-Allah, F, Abdollahi, M, Abedi, A, Abolhassani, H, Abosetugn, A, Abreu, L, Abrigo, M, Abu Haimed, A, Abushouk, A, Adabi, M, Adebayo, O, Adekanmbi, V, Adelson, J, Adetokunboh, O, Adham, D, Advani, S, Afshin, A, Agarwal, G, Agasthi, P, Aghamir, S, Agrawal, A, Ahmad, T, Akinyemi, R, Alahdab, F, Al-Aly, Z, Alam, K, Albertson, S, Alemu, Y, Alhassan, R, Ali, M, Ali, S, Alipour, V, Aljunid, S, Alla, F, Almadi, M, Almasi, A, Almasi-Hashiani, A, Almasri, N, Al-Mekhlafi, H, Almulhim, A, Alonso, J, Al-Raddadi, R, Altirkawi, K, Alvis-Guzman, N, Alvis-Zakzuk, N, Amini, S, Amini-Rarani, M, Amiri, F, Amit, A, Amugsi, D, Ancuceanu, R, Anderlini, D, 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D, Briant, P, Briggs, A, Briko, N, Burugina Nagaraja, S, Busse, R, Butt, Z, Caetano dos Santos, F, Cahuana-Hurtado, L, Cámera, L, Cárdenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castañeda-Orjuela, C, Castelpietra, G, Castro, F, Catalá-López, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, A, Charan, J, Chattu, V, Chaturvedi, S, Chin, K, Cho, D, Choi, J, Christensen, H, Chu, D, Chung, M, Ciobanu, L, Cirillo, M, Comfort, H, Compton, K, Cortesi, P, Costa, V, Cousin, E, Dahlawi, S, Damiani, G, Dandona, L, Dandona, R, Darega Gela, J, Darwesh, A, Daryani, A, Dash, A, Davey, G, Dávila-Cervantes, C, Davletov, K, De Neve, J, Denova-Gutiérrez, E, Deribe, K, Dervenis, N, Desai, R, Dharmaratne, S, Dhungana, G, Dianatinasab, M, Dias da Silva, D, Diaz, D, Dippenaar, I, Do, H, Dorostkar, F, Doshmangir, L, Duncan, B, Duraes, A, Eagan, A, Edvardsson, D, El Sayed, I, El Tantawi, M, Elgendy, I, Elyazar, I, Eskandari, K, Eskandarieh, S, Esmaeilnejad, S, 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Øverland, S, Owolabi, M, Padubidri, J, Pakhale, S, Palladino, R, Pana, A, Panda-Jonas, S, Pangaribuan, H, Pathak, M, Patton, G, Paudel, S, Pazoki Toroudi, H, Pease, S, Peden, A, Pennini, A, Peprah, E, Pereira, J, Pigott, D, Pilgrim, T, Pilz, T, Pinheiro, M, Piradov, M, Pirsaheb, M, Pokhrel, K, Postma, M, Pourjafar, H, Pourmalek, F, Pourmirza Kalhori, R, Pourshams, A, Prada, S, Pribadi, D, Pupillo, E, Quazi Syed, Z, Radfar, A, Rafiee, A, Rafiei, A, Raggi, A, Rahim, F, Rahman, M, Rajabpour-Sanati, A, Rana, S, Ranabhat, C, Rao, S, Rasella, D, Rashedi, V, Rath, G, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Razo, C, Renjith, V, Renzaho, A, Reshmi, B, Rezaei, N, Riahi, S, Ribeiro, D, Rickard, J, Roberts, N, Roever, L, Romoli, M, Ronfani, L, Roshandel, G, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, M, Sadeghi, E, Safari, Y, Sagar, R, Sahebkar, A, Sahraian, M, Sajadi, S, Salahshoor, M, Salem, M, Salem, H, Salomon, J, Samadi Kafil, H, Samy, A, Sanabria, 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University, Health Sciences, 10922180 - Schutte, Aletta Elisabeth, Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Akinyemi, R. O., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y. M., Alhassan, R. K., Ali, M., Ali, S., Alipour, V., Aljunid, S. M., Alla, F., Almadi, M. A. H., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C. L., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Aremu, O., Arnlov, J., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Athari, S. S., Atout, M. M. W., Ausloos, M., Avila-Burgos, L., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Aynalem, Y. A., Aynalem, G. L., Ayza, M. A., Azari, S., Azzopardi, P. S., B, D. B., Babaee, E., Badiye, A. D., Bahrami, M. A., Baig, A. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Banach, M., Banerjee, S. K., Banik, P. C., Bante, A. B., Bante, S. A., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B. A., Bedi, N., Beghi, E., Behzadifar, M., Bekuma, T. T. T., Bell, M. L., Bensenor, I. M., Berman, A. E., Bernabe, E., Bernstein, R. S., Bhagavathula, A. S., Bhandari, D., Bhardwaj, P., Bhat, A. G., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Bilano, V., Biondi, A., Birihane, B. M., Bockarie, M. J., Bohlouli, S., Bojia, H. A., Bolla, S. R. R., Boloor, A., Brady, O. J., Braithwaite, D., Briggs, A. M., Briko, N. I., Burugina Nagaraja, S., Busse, R., Butt, Z. A., Caetano dos Santos, F. L., Cahuana-Hurtado, L., Camera, L. A., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Catala-Lopez, F., Cederroth, C. R., Cerin, E., Chandan, J. S., Chang, A. Y., Charan, J., Chattu, V. K., Chaturvedi, S., Chin, K. L., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Ciobanu, L. G., Cirillo, M., Compton, K., Cortesi, P. A., Costa, V. M., Cousin, E., Dahlawi, S. M. A., Damiani, G., Dandona, L., Dandona, R., Darega Gela, J., Darwesh, A. M., Daryani, A., Dash, A. P., Davey, G., Davila-Cervantes, C. A., Davletov, K., De Neve, J. -W., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Desai, R., Dharmaratne, S. D., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dippenaar, I. N., Do, H. T., Dorostkar, F., Doshmangir, L., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Sayed, I., El Tantawi, M., Elgendy, I. Y., Elyazar, I. R., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Ezekannagha, O., Farag, T., Farahmand, M., Faraon, E. J. A., Farinha, C. S. E. S., Farioli, A., Faris, P. S., Faro, A., Fazlzadeh, M., Feigin, V. L., Fernandes, E., Ferrara, P., Feyissa, G. T., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gaidhane, A. M., Gakidou, E., Galles, N. C., Gallus, S., Gardner, W. M., Geberemariyam, B. S., Gebrehiwot, A. M., Gebremeskel, L. G., Gebremeskel, G. G., Gesesew, H. A., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Ghith, N., Gholamian, A., Gilani, S. A., Gill, P. S., Gill, T. K., Ginindza, T. G., Gitimoghaddam, M., Giussani, G., Glagn, M., Gnedovskaya, E. V., Godinho, M. A., Goharinezhad, S., Gopalani, S. V., Goudarzian, A. H., Goulart, B. N. G., Gubari, M. I. M., Guimaraes, R. A., Guled, R. A., Gultie, T., Guo, Y., Gupta, R., Hafezi-Nejad, N., Hafiz, A., Haile, T. G., Hamadeh, R. R., Hameed, S., Hamidi, S., Han, C., Han, H., Handiso, D. W., Hanif, A., Hankey, G. J., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hashi, A., Hassan, S., Hassan, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Herteliu, C., Hird, T. R., Ho, H. C., Hole, M. K., Holla, R., Hoogar, P., Hopf, K. P., Horita, N., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsieh, V. C. -R., Hu, G., Huda, T. M., Humayun, A., Hwang, B. -F., Iavicoli, I., Ibitoye, S. E., Ikeda, N., Ilesanmi, O. S., Ilic, M. D., Inbaraj, L. R., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Islami, F., Iso, H., Iwu, C. J., Jaafari, J., Jadidi-Niaragh, F., Jafarinia, M., Jahagirdar, D., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janjani, H., Javaheri, T., Jayatilleke, A. U., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jia, P., John-Akinola, Y. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, Z., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kanchan, T., Kapoor, N., Karami Matin, B., Karanikolos, M., Karimi, S. M., Kassebaum, N. J., Katikireddi, S. V., Kayode, G. A., Keiyoro, P. N., Khader, Y. S., Khammarnia, M., Khan, M., Khan, E. A., Khang, Y. -H., Khatab, K., Khater, A. M., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Kocarnik, J. M., Kochhar, S., Kohler, S., Kopec, J. A., Korotkova, A. V., Korshunov, V. A., Kosen, S., Kotlo, A., Koul, P. A., Koyanagi, A., Krishan, K., Krohn, K. J., Kugbey, N., Kulkarni, V., Kumar, G. A., Kumar, N., Kumar, M., Kurmi, O. P., Kusuma, D., Kyu, H. H., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Landires, I., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lau, K. M. -M., Lauriola, P., Lazarus, J. V., Ledesma, J. R., Lee, P. H., Lee, S. W. H., Leever, A. T., Legrand, K. E., Leigh, J., Leonardi, M., Li, S., Lim, S. S., Lim, L. -L., Liu, X., Logroscino, G., Lopez, A. D., Lopukhov, P. D., Lotufo, P. A., Lu, A., Ma, J., Madadin, M., Mahasha, P. W., Mahmoudi, M., Majeed, A., Malagon-Rojas, J. N., Maleki, S., Malta, D. C., Mansouri, B., Mansournia, M. A., Martini, S., Martins-Melo, F. R., Martopullo, I., Massenburg, B. B., Mastrogiacomo, C. I., Mathur, M. R., Mcalinden, C., Mckee, M., Medina-Solis, C. E., Meharie, B. G., Mehndiratta, M. M., Mehrabi Nasab, E., Mehri, F., Mehrotra, R., Mekonnen, T., Melese, A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, T. J., Meretoja, A., Mestrovic, T., Miazgowski, B., Michalek, I. M., Mirrakhimov, E. M., Mirzaei, M., Mirzaei-Alavijeh, M., Mitchell, P. B., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Mohammad, D. K., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammed, S., Mohammed, J. A., Mokdad, A. H., Monasta, L., Mondello, S., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mousavi Khaneghah, A., Muriithi, M. K., Mustafa, G., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Nangia, V., Nansseu, J. R., Nayak, V. C., Nazari, J., Ndejjo, R., Negoi, I., Negoi, R. I., Neupane, S., Ngari, K. N., Nguefack-Tsague, G., Ngunjiri, J. W., Nguyen, C. T., Nguyen, D. N., Nguyen, H. L. T., Nnaji, C. A., Nomura, S., Norheim, O. F., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Oluwasanu, M. M., Omar Bali, A., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Ortega-Altamirano, D. V. V., Ortiz, A., Ostojic, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., Padubidri, J. R., Pakhale, S., Palladino, R., Pana, A., Panda-Jonas, S., Pangaribuan, H. U., Pathak, M., Patton, G. C., Paudel, S., Pazoki Toroudi, H., Pease, S. A., Peden, A. E., Pennini, A., Peprah, E. K., Pereira, J., Pigott, D. M., Pilgrim, T., Pilz, T. M., Pinheiro, M., Piradov, M. A., Pirsaheb, M., Pokhrel, K. N., Postma, M. J., Pourjafar, H., Pourmalek, F., Pourmirza Kalhori, R., Pourshams, A., Prada, S. I., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahim, F., Rahman, M. A., Rajabpour-Sanati, A., Rana, S. M., Ranabhat, C. L., Rao, S. J., Rasella, D., Rashedi, V., Rath, G. K., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Razo, C., Renjith, V., Renzaho, A. M. N., Reshmi, B., Rezaei, N., Riahi, S. M., Ribeiro, D. C., Rickard, J., Roberts, N. L. S., Roever, L., Romoli, M., Ronfani, L., Roshandel, G., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, M., Sadeghi, E., Safari, Y., Sagar, R., Sahebkar, A., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salem, M. R. R., Salem, H., Salomon, J., Samadi Kafil, H., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Savic, M., Sawyer, S. M., Saxena, D., Sbarra, A. N., Schaeffer, L. E., Schiavolin, S., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Sha, F., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharara, F., Sharifi, H., Shaw, D. H., Sheikh, A., Sheikhtaheri, A., Shetty, B. S. K., Shibuya, K., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shiri, R., Shirkoohi, R., Shivakumar, K. M., Shrime, M. G., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, D. A. S., Silva, J. P., Simonetti, B., Simpson, K. E., Singh, J. A., Singh, P., Sinha, D. N., Skryabin, V. Y., Smith, E. U. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Spurlock, E. E., Sreeramareddy, C. T., Stanaway, J. D., Steel, N., Stein, C., Stokes, M. A., Sufiyan, M. B., Suleria, H. A. R., Sultan, I., Szumowski, L., Tabares-Seisdedos, R., Tabuchi, T., Tadakamadla, S. K., Taddele, B. W., Tadesse, D. B., Taherkhani, A., Tamiru, A. T., Tanser, F. C., Tareque, M. I., Tarigan, I. U., Teagle, W. L., Tediosi, F., Tefera, Y. G. G., Tela, F. G., Tessema, Z. T., Thakur, B., Titova, M. V., Tonelli, M., Topor-Madry, R., Topouzis, F., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Troeger, C. E., Tudor Car, L., Uddin, R., Ullah, I., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Vacante, M., Valdez, P. R., Varughese, S., Vasankari, T. J., Vasseghian, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vongpradith, A., Vos, T., Waheed, Y., Walters, M. K., Wamai, R. G., Wang, H., Wang, Y. -P., Weintraub, R. G., Weiss, J., Werdecker, A., Westerman, R., Wilner, L. B., Woldu, G., Wolfe, C. D. A., Wu, A. -M., Wulf Hanson, S., Xie, Y., Yahyazadeh Jabbari, S. H., Yamagishi, K., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yearwood, J. A., Yeshitila, Y. G., Yip, P., Yonemoto, N., Younis, M. Z., Yousefi, Z., Yousefinezhadi, T., Yusefzadeh, H., Zadey, S., Zahirian Moghadam, T., Zaidi, S. S., Zaki, L., Zaman, S. B., Zamanian, M., Zandian, H., Zastrozhin, M. S., Zewdie, K. A., Zhang, Y., Zhao, X. -J. G., Zhao, Y., Zheng, P., Zhu, C., Ziapour, A., Zlavog, B. S., Zodpey, S., and Murray, C. J. L.

Subjects
Index (economics), Servicios de Salud, SUSTAINABLE DEVELOPMENT GOALS, 030204 cardiovascular system & hematology, universal health coverage, sustaibale develpment goal, global burden of disease, performance, systematic analysis, Global Burden of Disease, 0302 clinical medicine, Universal Health Insurance, RA0421, 11. Sustainability, Per capita, Medical economics, Disease, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, effective coverage of health services, GBD 2019 Universal Health Coverage Collaborators, education.field_of_study, Public health, Medical care, Sjúkdómar, 4. Education, 1. No poverty, Health coverage, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Hälsovetenskaper, 3142 Public health care science, environmental and occupational health, Health services, 3. Good health, Global burden of disease, Health Expenditures, Humans, World Health Organization, Purchasing power parity, Scale (social sciences), Lýðheilsa, universal health coverag, CANCER SURVIVAL, ACCESS, Human, Heilsuhagfræði, medicine.medical_specialty, Health coverage, GBD, GBD, Universal health, GBD 2019, Population, Health expenditures, 3122 Cancers, Population health, 03 medical and health sciences, Health systems, Heilbrigðisvísindi, SDG 3 - Good Health and Well-being, General & Internal Medicine, Development economics, Health Sciences, medicine, Heilbrigðisstefna, Alþjóðaheilbrigðisstofnunin, QUALITY, Global Burden of Disease Study, education, PROGRESS, Disease burden, Health services accessibility, CARE, Heilbrigðisþjónusta, purl.org/pe-repo/ocde/ford#3.02.00 [https], Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, Morbility, Administración de los Servicios de Salud, Medical policy, Business, Heilbrigðiskerfi
Abstract

Publisher's version (útgefin grein), Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"

Published
2020
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33. Radiofrequency catheter ablation of accessory pathways in patients with Ebstein’s anomaly: At 8 years of follow-up

Author

Łukasz Szumowski, Paweł Derejko, Katarzyna Bieganowska, Maria Miszczak-Knecht, Radosław Sierpiński, Elżbieta Katarzyna Biernacka, Joanna Zakrzewska-Koperska, Maria Bilińska, Andrzej Hasiec, Piotr Hoffman, Michał Orczykowski, Robert Bodalski, Katarzyna Kalin, Rafał Baranowski, Grzegorz Warmiński, and Piotr Urbanek

Subjects
Adult, Male, Tachycardia, medicine.medical_specialty, Time Factors, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, Accessory pathway, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Ebstein's anomaly, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, business.industry, General Medicine, medicine.disease, Ablation, Accessory Atrioventricular Bundle, Surgery, Ebstein Anomaly, Treatment Outcome, Heart failure, Catheter Ablation, Cardiology, Female, medicine.symptom, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, business, Atrial flutter, Follow-Up Studies
Abstract

Background: Data regarding long-term follow-up of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in patients with Ebstein’s anomaly (EA) are limited. The procedures are challenging due to multiple or wide APs. Methods: Analysis was performed on clinical and periprocedural data of patients with EA referred to the centre in order to perform catheter ablation of AP. The group consisted of 22 patients (female 40.9%, mean age 33.6 ± 19.1 years). The follow-up utilized electrocardiogram and Holter monitoring. Results: Twenty-two patients had 33 accessory pathways (8 patients had multiple APs, 11 patients broad AP). Twenty-nine different arrhythmias were ablated: 20 orthodromic atrioventricular reciprocating tachycardia (O-AVRT), 5 antidromic atrioventricular reciprocating tachycardia (A-AVRT), 3 slow/ fast atrioventricular nodal reentry tachycardia (s/f AVNRT) and 1 cavotricuspid-isthmus-dependent atrial flutter (CTI-AFL). In 3 (13.6%) patients multiple ablation targets for RFCA ablation were observed. The acute procedural success rate after the first RFCA performed was: 100% for AVNRT, 77.3% for APs and 50.0% for CTI-AFL ablation. Follow-up (mean 95.7 ± 49.8 months) was completed in 86.4% of patients. One patient had paroxysmal atrial fibrillation not targeted during ablation. One patient died due to heart failure 12 years after RFCA. Three patients who underwent RFCA of accessory pathways in the mid-1990s were lost in follow-up. Conclusions: Radiofrequency ablation in patients with EA is challenging but safe and have a high short-term as well as long-term success rate.

Published
2017
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34. Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Author

Łukasz Szumowski, Elżbieta Katarzyna Biernacka, Andrzej Przybylski, Marek Konka, Krzysztof Bernard Poślednik, Piotr Hoffman, and Olgierd Woźniak

Subjects
Heart transplantation, medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, Cardiac resynchronization therapy, Implantable cardioverter-defibrillator, medicine.disease, Right ventricular cardiomyopathy, Sudden cardiac death, medicine.anatomical_structure, Ventricle, Internal medicine, Heart failure, medicine, Cardiology, business, education
Abstract

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation. As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons. Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR). Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant). Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Further studies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.

Published
2016
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35. Atrial tachycardia ablation in patients with a functional single ventricle after the Fontan surgery

Author

Mirosław Kowalski, Elżbieta Katarzyna Biernacka, Robert Bodalski, Piotr Urbanek, Michał Orczykowski, Łukasz Szumowski, Justyna Rybicka, Piotr Hoffman, Joanna Duliban, Franciszek Walczak, Artur Oręziak, and Paweł Derejko

Subjects
Adult, Male, medicine.medical_specialty, business.industry, Heart Ventricles, Fontan Procedure, Surgery, Functional single ventricle, Young Adult, Postoperative Complications, Treatment Outcome, Child, Preschool, Tachycardia, Internal medicine, Catheter Ablation, medicine, Cardiology, Humans, Female, In patient, Heart Atria, Child, Cardiology and Cardiovascular Medicine, business, Retrospective Studies
Abstract

Wstep: Czestoskurcze przedsionkowe (AT) są jedną z wiodących przyczyn chorobowości i śmiertelności u pacjentow po operacji Fontana, a skutecznośc terapii lekami antyarytmicznymi w tej grupie chorych jest z reguly ograniczona. Cel: Celem pracy byla ocena wynikow bezpośrednich i odleglych ablacji AT u pacjentow po operacji Fontana oraz ocena charakterystyki klinicznej, elektrofizjologicznej i elektroanatomicznej arytmii. Metody: Retrospektywną analizą objeto dane 8 pacjentow (5 mezczyzn, 3 kobiety) po operacji Fontana kierowanych na ablacje w latach 2002–2013 z powodu AT. Istotnośc kliniczną i nasilenie arytmii przed i po ablacji oceniono za pomocą zmodyfikowanego wskaźnika arytmicznego. Jest on sumą czterech skladowych wartościujących, takich jak: 1) maksymalny czas trwania arytmii, 2) objawy związane z arytmią, 3) metody przerywania arytmii, 4) terapia antyarytmiczna konieczna do zapobiegania napadom. Wskaźnik ten przyjmuje wartości od 0 (bez istotnej arytmii) do 12 punktow (ciezka arytmia). U wszystkich pacjentow zabiegi ablacji wykonywano z zastosowaniem systemu CARTO, co pozwolilo na polilościową ocene wielkości obszarow niskoamplitudowych (< 0,5 mV) i blizn w obrebie przedsionka. Wyniki: U 7 chorych obecne bylo polączenie prawy przedsionek–tetnica plucna, a u 1 chorego — tunel zewnątrzsercowy. Średni wiek pacjentow w trakcie wykonania operacji Fontana wynosil 9,4 ± 3,1 roku, a w trakcie wykonywania pierwszej ablacji — 26,2 ± 4,6 roku. W badanej grupie wykonano lącznie 18 ablacji bez istotnych powiklan, 1–4 ablacje/chorego; mediana 2,5. U pacjentow, u ktorych przeprowadzono wiecej niz 1 ablacje, odstep czasu miedzy pierwszym a ostatnim zabiegiem wynosil średnio 34,8 miesiąca (zakres 1–64 miesiące). W trakcie zabiegow u poszczegolnych pacjentow obserwowano od 1 do ponad 4 roznych morfologii czestoskurczow (mediana 2,5). Średni cykl AT wynosil 334 ± 95 ms. U 6 pacjentow obszary istotnego uszkodzenia z amplitudą < 0,5 mV zajmowaly 25–50% powierzchni prawego przedsionka, a u dwoch kolejnych osob, odpowiednio, 10–25% i < 10% jego powierzchni. Siedem ablacji bylo w pelni skuteczne (usunieto wszystkie AT — kliniczne i wywolane stymulacją), kolejne 7 ablacji bylo cześciowo skuteczne (nie usunieto wszystkich arytmii, ale usunieto kliniczny AT), a 4 ablacje byly nieskuteczne (nie usunieto klinicznego AT). Średnie czasy zabiegu, skopii rentgenowskiej i dostarczania energii o czestotliwości radiowej wynosily odpowiednio: 176 ± 54,6; 13,7 ± 5,7 i 21,7 ± 11,9 minut. W obserwacji odleglej, średnio 58,6 ± 46 (zakres 11–127) miesiecy po ostatniej ablacji, u 4 pacjentow nie stwierdzono arytmii. Mediana wskaźnika arytmicznego przed pierwszą ablacją wynosila 8 punktow, a po ostatniej ablacji — 4,5 punktu (p < 0.05). Wnioski: Ablacja AT u pacjentow po operacji Fontana jest zabiegiem bezpiecznym, ale jej skutecznośc bezpośrednia i odlegla jest ograniczona. Wynika to z rozleglego i zlozonego substratu oraz trudnych warunkow anatomicznych. Uzyskanie dobrych efektow moze wymagac wykonania wiecej niz jednej ablacji. Opanowanie arytmii przyczynia sie do poprawy stanu klinicznego pacjentow.

Published
2016
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37. Do we differ in terms of indications and demographics in cardiac resynchronisation recipients in Poland? Insights from the European CRT Survey II Registry

Author

Mateusz Tajstra, Camilla Normand, Bogdan Galar, Kenneth Dickstein, Krystian Josiak, Adam Sokal, Damian Łasocha, Maciej Sterliński, Łukasz Januszkiewicz, Rafał Sznajder, Dariusz Zając, Sławomir Tłuczek, Jarosław Kaźmierczak, Cecilia Linde, and Łukasz Szumowski

Subjects
Male, medicine.medical_specialty, Demographics, medicine.medical_treatment, Population, Cardiac resynchronization therapy, Cardiac Resynchronization Therapy, Medicine, Humans, In patient, Registries, education, National data, Aged, Demography, Aged, 80 and over, Heart Failure, education.field_of_study, business.industry, Guideline, Middle Aged, medicine.disease, Clinical trial, Europe, Heart failure, Emergency medicine, Female, Poland, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Multiple randomised clinical trials have proven that cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with congestive heart failure and is recommended for such patients as per the European Society of Cardiology guidelines. Aims: In this paper we compare the indications and demographics in cardiac resynchronisation recipients in Poland and other European countries. Methods: In 2015 and 2016 , physicians from 42 European countries participated in the second edition of the European Cardiac Resynchronisation Therapy Survey. For 14 months, 288 implanting centres gathered data regarding demography, indications, implanting methods, and guidance compatibility from 11,088 patients receiving CRT. Results: The survey revealed that a vast group of patients were eligible for CRT implantation (although some of them with rela­tively weak guidance recommendations) and showed essential variety in clinical practice when national data were benchmarked. Conclusions: The population of CRT recipients in Poland and other European countries did not differ in terms of demographic and clinical characteristics. In most cases, indications for CRT were in accordance with the guidelines; however some devices were implanted in patients beyond the guideline recommendations. For these procedures, the decision regarding CRT im­plantation relies mainly on the physicians’ experience.

Published
2018

38. Ventricular fibrillation induced by radiofrequency energy delivery for premature ventricular contractions arising from the right ventricular outflow tract: is implantablecardioverterdefibrillator indicated?

Author

Michał, Orczykowski, Paweł, Derejko, Piotr, Urbanek, Robert, Bodalski, Radosław, Lenarczyk, Dariusz, Kozłowski, Edward, Koźluk, Damian, Łasocha, Maciej, Sterliński, Zbigniew, Kalarus, Maria, Bilińska, and Łukasz, Szumowski

Subjects
Adult, Male, Young Adult, Radio Waves, Heart Ventricles, Ventricular Fibrillation, Humans, Female, Prognosis, Radiofrequency Therapy, Ventricular Premature Complexes, Aged, Defibrillators, Implantable
Abstract

INTRODUCTION Inadvertently induced ventricular fibrillation (VF) by radiofrequency (RF) energy delivery for premature ventricular complexes (PVCs) is a rare phenomenon; nevertheless, it is crucial to assess long‑term risk of sudden cardiac death in these patients. OBJECTIVES The aim of our study was to define the long‑term prognosis in patients with normal ejection fraction (EF), in whom VF was inadvertently induced by RF energy application during ablation of symptomatic idiopathic PVCs originating from the right ventricular outflow tract (RVOT). PATIENTS AND METHODS Among over 20 000 RF catheter ablations performed at 5 tertiary centers (2008-2016), 6 patients (5 men) had VF induced by RF application to the RVOT. The mean (SD) age of patients was 35.2 (16.8) years. All patients had normal EF (≥60%). We analyzed the risk of malignant ventricular arrhythmias and assessed heart function during follow‑up. RESULTS After ablation, baseline contrast‑enhanced magnetic resonance imaging was performed in 4 of the 6 patients; no area of late gadolinium enhancement was observed. One patient received an implantable cardioverter‑defibrillator (ICD). Exercise tests revealed only rare PVCs. All patients completedthe follow‑up (mean [SD] duration of follow‑up, 64.0 [34.9] months). All patients were alive, with no cases of syncope, documented ventricular tachycardia, or VF. The patient with an ICD received 2 inappropriate high‑voltage therapies. CONCLUSIONS Patients with inadvertently induced VF via RF energy application during ablation of PVCs from the RVOT, who have normal left ventricular function and no electrocardiography abnormalities have good prognosis and low VF risk during long‑term follow‑up. Therefore, ICD placement seems to be not indicated for these patients.

Published
2018

39. Temperament, stress, and atrial fibrillation

Author

Łukasz Szumowski, Agnieszka Maryniak, Andrzej Hasiec, Bartosz Duda, and Michał Orczykowski

Subjects
medicine.medical_specialty, Autonomic nervous system, Internal medicine, media_common.quotation_subject, Stress (linguistics), medicine, Cardiology, Atrial fibrillation, Temperament, medicine.disease, Psychology, General Psychology, media_common
Abstract

In some patients with atrial fibrillation (AF), the causative agent of attack is stress (AF associated with adrenergic activity). In others, AF usually begins during relax or sleep (AF associated with vagal nerve dominance). This study aimed to investigate the individual factors associated with the adrenergic or vagal type of AF. This study included 138 patients with paroxysmal atrial fibrillation (AF). Sixty-eight patients reported that AF was frequently triggered by stress (sympathetic-type AF) and 70 patients reported that AF usually began during relaxation or sleep (vagal-type AF). Gender, age, ejection fraction, and temperament were compared across the two groups. Temperament was evaluated using the Formal Characteristics of Behaviour-Temperament Inventory. The groups differed only in temperament. Patients with sympathetic-type AF had a higher score for emotional reactivity (p = 0.002) and perseverance (p = 0.002) temperament traits and a lower score for endurance (p = 0.003) than patients with vagal-type AF and than the average in population.

Published
2015
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40. Ventricular fibrillation induced by a radiofrequency energy delivery for premature ventricular contractions arising from the right ventricular outflow tract – is ICD indicated?

Author

Łukasz Szumowski, Damian Łasocha, Maria Bilińska, Zbigniew Kalarus, Radosław Lenarczyk, Paweł Derejko, Robert Bodalski, Maciej Sterliński, Dariusz Kozłowski, Michał Orczykowski, Piotr Urbanek, and Edward Koźluk

Subjects
medicine.medical_specialty, Ejection fraction, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Magnetic resonance imaging, medicine.disease, Ventricular tachycardia, Ablation, Sudden cardiac death, Internal medicine, Ventricular fibrillation, Internal Medicine, medicine, Cardiology, Ventricular outflow tract, business, Electrocardiography
Abstract

INTRODUCTION Inadvertently induced ventricular fibrillation (VF) by radiofrequency (RF) energy delivery for premature ventricular complexes (PVCs) is a rare phenomenon; nevertheless, it is crucial to assess long‑term risk of sudden cardiac death in these patients. OBJECTIVES The aim of our study was to define the long‑term prognosis in patients with normal ejection fraction (EF), in whom VF was inadvertently induced by RF energy application during ablation of symptomatic idiopathic PVCs originating from the right ventricular outflow tract (RVOT). PATIENTS AND METHODS Among over 20 000 RF catheter ablations performed at 5 tertiary centers (2008-2016), 6 patients (5 men) had VF induced by RF application to the RVOT. The mean (SD) age of patients was 35.2 (16.8) years. All patients had normal EF (≥60%). We analyzed the risk of malignant ventricular arrhythmias and assessed heart function during follow‑up. RESULTS After ablation, baseline contrast‑enhanced magnetic resonance imaging was performed in 4 of the 6 patients; no area of late gadolinium enhancement was observed. One patient received an implantable cardioverter‑defibrillator (ICD). Exercise tests revealed only rare PVCs. All patients completedthe follow‑up (mean [SD] duration of follow‑up, 64.0 [34.9] months). All patients were alive, with no cases of syncope, documented ventricular tachycardia, or VF. The patient with an ICD received 2 inappropriate high‑voltage therapies. CONCLUSIONS Patients with inadvertently induced VF via RF energy application during ablation of PVCs from the RVOT, who have normal left ventricular function and no electrocardiography abnormalities have good prognosis and low VF risk during long‑term follow‑up. Therefore, ICD placement seems to be not indicated for these patients.

Published
2018
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41. Augmented-reality computed tomography-guided transcatheter pacemaker implantation in dextrocardia and congenitally corrected transposition of great arteries

Author

Ilona Michałowska, Maksymilian P. Opolski, Barbara Nicińska, Bartosz Borucki, Łukasz Szumowski, and Maciej Sterliński

Subjects
Adult, Male, medicine.medical_specialty, Pacemaker, Artificial, Computed Tomography Angiography, Transposition of Great Vessels, Computed tomography, Dextrocardia, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Pacemaker implantation, 03 medical and health sciences, 0302 clinical medicine, Heart Conduction System, Internal medicine, Medicine, Humans, Cardiac Surgical Procedures, Atrioventricular Block, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, Congenitally corrected transposition, Great arteries, Cardiology, Augmented reality, Cardiology and Cardiovascular Medicine, business
Published
2018

42. Safety of a simplified electrophysiological method of transseptal puncture. A single center's experience

Author

Damian Łasocha, Maria Bilińska, Łukasz Szumowski, Piotr Urbanek, Małgorzata Łodyga, and Michał Orczykowski

Subjects
medicine.medical_specialty, business.industry, Short Communication, MEDLINE, 030204 cardiovascular system & hematology, Single Center, 03 medical and health sciences, 0302 clinical medicine, Text mining, medicine, Medical physics, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Published
2018

43. Idiopathic ventricular arrhythmia in children and adolescents: early effectiveness of radiofrequency current ablation

Author

Anna Turska-Kmieć, Monika Brzezińka-Paszke, Katarzyna Bieganowska, Łukasz Szumowski, Maria Miszczak-Knecht, Franciszek Walczak, Maria Posadowska, and Katarzyna Pręgowska

Subjects
Male, Pediatrics, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Catheter ablation, Treatment results, Fascicular Tachycardia, Patient age, Internal medicine, medicine, Humans, cardiovascular diseases, Child, business.industry, Arrhythmias, Cardiac, Ablation, Posterior Fascicle, Cardiac surgery, Early Diagnosis, Treatment Outcome, medicine.anatomical_structure, Ventricle, Child, Preschool, Catheter Ablation, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background and aim: The aim of the study was to evaluate early effectiveness of radiofrequency (RF) current ablation for idiopathic ventricular arrhythmia (iVA) in children and to identify factors affecting treatment results. Methods: Among over 600 children, 30 ablation procedures were performed for iVA. Patient age ranged from 2.0 to 17.9 years (mean 14.7 ± 3.1). We analysed arrhythmia recurrences at 24 h and the effect of patient age, arrhythmia location, type of anaesthesia, and the presence of spontaneous arrhythmia during the procedure on the treatment results. Results: Sixteen (53%) children had right ventricular (RV) arrhythmia, including RV outflow tract arrhythmia in 9 of them (56%). In 14 (47%) children, arrhythmia was located in the left ventricle (LV), including LV outflow tract in 2 children, and the posterior fascicle in 4 children. The procedure was effective in 13 (81%) children in the RV arrhythmia group and in 11 (78%) children inthe LV arrhythmia group, including all children with fascicular tachycardia. The only variable that affected the treatment results was the presence of spontaneous arrhythmia during the procedure (p = 0.012). No procedural complications were noted. Conclusions: RF current ablation of iVA is a safe procedure with high early effectiveness. The only variable that affected the treatment results was the presence of spontaneous arrhythmia during the procedure.

Published
2014
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44. Early stage of left atrium remodelling predicts better outcome in long-term follow-up of atrial fibrillation ablation

Author

Maria Bilińska, Robert Bodalski, Andrzej Przybylski, Paweł Derejko, Piotr Urbanek, Łukasz Szumowski, Ilona Michałowska, Michał Orczykowski, Łukasz Kalińczuk, Franciszek Walczak, Artur Oręziak, Joanna Zakrzewska-Koperska, and Zbigniew Jedynak

Subjects
Adult, Male, medicine.medical_specialty, Long term follow up, medicine.medical_treatment, Left atrium, Pulmonary vein, Internal medicine, Atrial Fibrillation, medicine, Humans, In patient, Heart Atria, Stage (cooking), business.industry, Atrial fibrillation, Atrial Remodeling, Middle Aged, Ablation, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, Pulmonary Veins, Radiofrequency catheter ablation, Catheter Ablation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background: Radiofrequency catheter ablation (RFCA) has been increasingly used for the treatment of patients with symptomatic atrial fibrillation (AF). Aim: To identify simple pre-procedural success predictors of RFCA in patients with AF. Methods and Results: It comprised 294 consecutive patients (mean age 54 ± 11 years, 71% male) with symptomatic AF (28% — paroxysmal with short episodes (< 12 h); 50% — paroxysmal with episodes ≥ 12 h and < 7 days; 11.5% — persistent; 10.5% — long standing persistent), having undergone the first RFCA. Before RFCA, all patients underwent pulmonary vein (PV) anatomy imaging and echocardiographic left atrium diameter (LAD) evaluation. PV periostial or antral isolation guided by electroanatomical mapping was performed with additional lines or complex fractionated electrograms ablation (if required). Outcomes were defined as clinical success (complete or improvement) or failure. After a mean follow-up of 36.9 ± 13 months, clinical success was observed in 90.5% of patients, made up of 47.3% complete success, and 43.2% improvement. Patients with short AF episodes underwent fewer procedures (1.6 vs. 2, p = 0.026) and had the highest clinical (97.6%) and complete (63.9%) success rates. AF episodes < 12 h (p < 0.001), LAD < 4 cm (p = 0.01) and male gender (p = 0.002) independently predicted RFCA long-term clinical success. PV anatomy did not correlate with RFCA outcome. A trend was observed towards a larger number of procedures in patients with atypical PV anatomy (p = 0.059). Conclusions: AF ablation should be performed in the early stage of AF, before structural remodelling development.

Published
2014
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45. Effect of the Restitution Properties of Cardiac Tissue on the Repeatability of Entrainment Mapping Response

Author

Franciszek Walczak, Paweł Derejko, Łukasz Szumowski, Jan J. Żebrowski, and Piotr Podziemski

Subjects
Adult, Male, Tachycardia, medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, Risk Assessment, Sampling Studies, Nerve conduction velocity, law.invention, law, Physiology (medical), Internal medicine, Preoperative Care, medicine, Humans, Tachycardia, Atrioventricular Nodal Reentry, Computer Simulation, Prospective Studies, Aged, business.industry, Cardiac Pacing, Artificial, Recovery of Function, Repeatability, Electric Stimulation, Restitution, Electrophysiology, Catheter Ablation, cardiovascular system, Cardiology, Female, medicine.symptom, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, Entrainment (chronobiology), business, Follow-Up Studies
Abstract

Background— The difference between the postpacing interval (PPI) and the tachycardia cycle length (TCL; PPI−TCL) is a useful tool in mapping macro-reentrant tachycardias. However, entrainment pacing causes some perturbation of the conduction velocity within the tachycardia circuit, which may affect the repeatability and consequently the accuracy of the measurement of PPI−TCL. The aim of this study was to assess PPI−TCL repeatability both in vivo and in silico. Methods and Results— In the experimental part, entrainment pacing was performed twice at each of the 124 tested sites for 30 patients undergoing radiofrequency ablation of atrial and ventricular re-entrant arrhythmias. A similar protocol was used in a simplified computer model of the cardiac tachycardia circuit in a 2-dimensional tissue strip using a Fenton–Karma model of cardiac tissue. In vivo, in the case of fast tachycardias (350 ms; 95% Limits of Agreement ranged from −21.4 to 21.6 ms for TCL350 ms). Simulations show that this increase of variability may be because of the oscillations of the conduction velocity inside the tachycardia circuits. The effect of the restitution properties of cardiac tissue on the outcome of entrainment pacing is discussed. Conclusions— PPI−TCL is characterized by a high repeatability with the differences between the results for individual stimulations of ≤20 ms. The variability of this parameter is significantly lower in the case of slow tachycardias.

Published
2014
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46. Translation and cultural adaptation of a Patient Perception of Arrhythmia Questionnaire in Poland

Author

Michał M. Farkowski, Hanna Szwed, Kathryn A. Wood, Łukasz Szumowski, Mariusz Pytkowski, and Dominik Golicki

Subjects
Male, Pediatrics, medicine.medical_specialty, business.industry, Health Status, Reproducibility of Results, Arrhythmias, Cardiac, Middle Aged, Patient perceptions, Surveys and Questionnaires, Quality of Life, Humans, Medicine, Female, Poland, Theology, Cardiology and Cardiovascular Medicine, business, Attitude to Health, Aged
Abstract

Wstep: Kwestionariusz Patient Perception of Arrhythmia Questionnaire (PPAQ) jest specyficznym dla choroby narzedziem przeznaczonym do pomiaru jakości zycia związanej ze zdrowiem pacjentow cierpiących z powodu arytmii, kolektywnie nazywanych czestoskurczami nadkomorowymi. Brak prawidlowo przygotowanego tlumaczenia kwestionariusza PPAQ na jezyk polski ogranicza mozliwości badan nad jakością zycia polskich pacjentow cierpiących na arytmie nadkomorowe. Cel: Celem badania bylo przeprowadzenie procesu tlumaczenia i adaptacji kulturowej angielskiej wersji kwestionariusza PPAQ na jezyk polski. Metody: Proces przekladu i wstepne badanie trafności treściowej kwestionariusza przeprowadzono zgodnie z wytycznymi ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures opublikowanymi w 2005 r. Wyniki: W 2011 r. dokonano przekladu kwestionariusza na jezyk polski, a w procesie adaptacji kulturowej wzielo udzial 20 pacjentow (12 mezczyzn, średnia wieku 54,9 ± 17,4 roku). W trakcie procesu zidentyfikowano problemy związane z bliskim znaczeniem niektorych nazw objawow arytmii i charakterystycznymi dla jezyka polskiego zwrotami grzecznościowymi zaleznymi od plci. Pierwszy problem rozwiązano poprzez wspolprace z dwoma ekspertami z zakresu arytmii serca, a drugi poprzez zbadanie preferencji pacjentow w trakcie procesu walidacji. Wnioski: Polska wersja kwestionariusza byla powszechnie akceptowana przez pacjentow uczestniczących w procesie walidacji. Napotkane problemy mogą powtorzyc sie w tlumaczeniach na inne jezyki i mogą zostac rozwiązane w podobny sposob jak w niniejszej pracy.

Published
2014
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47. Arrhythmogenic right ventricular cardiomyopathy in contemporary imaging. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

Author

Krystian Wita, Elżbieta Katarzyna Biernacka, Andrzej Szyszka, Edyta Płońska-Gościniak, Katarzyna Mizia-Stec, Katarzyna Gruszczyńska, Łukasz Szumowski, Maciej T. Wybraniec, Łukasz A. Małek, and Jarosław D. Kasprzak

Subjects
Diagnostic Imaging, medicine.medical_specialty, Statement (logic), business.industry, Expert consensus, Right ventricular cardiomyopathy, Internal medicine, medicine, Cardiology, Humans, Poland, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Arrhythmogenic Right Ventricular Dysplasia
Published
2014
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48. Ablation of Macro-Re-Entrant Atrial Arrhythmia Late after Surgical Aortic Valve Replacement

Author

Michał, Orczykowski, Paweł, Derejko, Piotr, Urbanek, Robert, Bodalski, Katarzyna, Kodziszewska, Radosław, Sierpiński, Rafał, Baranowski, Maria, Bilińska, and Łukasz, Szumowski

Subjects
Adult, Heart Valve Prosthesis Implantation, Male, Time Factors, Adolescent, Arrhythmias, Cardiac, Middle Aged, Postoperative Complications, Aortic Valve, Catheter Ablation, Humans, Female, Cardiac Electrophysiology, Child, Aged, Follow-Up Studies
Abstract

Re-entrant atrial arrhythmias are common in patients after cardiac surgery. To date, however, no studies have reported the safety and efficacy of radiofrequency (RF) ablation of macro-re-entrant atrial arrhythmias in a unique, homogeneous group of patients after surgical replacement of the aortic valve and single right atriotomy.Among over 4,000 RF catheter ablations performed at the authors' center between 2008 and 2014, eight patients (seven males, one female; mean age 55.1 ± 19.9 years) after aortic valve replacement (AVR) and without history of any other cardiosurgical procedures were identified with documented macro-re-entrant atrial arrhythmia. The mechanism of macro-re-entrant arrhythmia was analyzed, as well as the safety and efficacy of RF ablation in a group of patients after AVR and single right atrial free wall atriotomy.The average time from surgery to RF catheter ablation was 11.3 ± 11.3 years (range: 4-35 years). In five patients with permanent arrhythmia, entrainment mapping proved these arrhythmias to be cavotricuspid isthmus- dependent, in three patients with paroxysmal atrial arrhythmia cavotricuspid isthmus-dependent atrial flutter was induced during the electrophysiological study. Intra-atrial re-entrant tachycardia was neither recorded nor induced in any patient. Successful ablation of cavotricuspid isthmus is defined as the termination of arrhythmia, and bidirectional block in cavotricuspid isthmus was achieved in all patients. A long-term follow up, based on a seven-day Holter monitoring, was conducted in all patients, with a mean observation time of 40.1 ± 28.6 months after the procedure. Among the patients, ablated arrhythmia (cavotricuspid isthmusdependent atrial flutter) recurred in one patient, atrial fibrillation occurred in three patients, and an atrial tachycardia in one patient.In the presented series of patients, cavotricuspid isthmus-dependent atrial flutter was shown to be the mechanism of post-cardiosurgical macro-re-entrant clinical arrhythmia in all subjects. Atrial fibrillation was frequently observed among those patients during follow up.

Published
2017

49. Relationship between Cycle Length of Typical Atrial Flutter and Double Potential Interval after Achievement of Complete Isthmus Block

Author

Robert Bodalski, Michał Orczykowski, Magdalena Polańska, Michel Haïssaguerre, Franciszek Walczak, Joanna Zakrzewska-Koperska, Paweł Derejko M.D., Roman Kępski, Łukasz Szumowski, Ewa Szufladowicz, Anna Wójcik, Dariusz Kozłowski M.D., Lidia Chojnowska, Piotr Urbanek, and Frederic Sacher

Subjects
medicine.medical_specialty, Cavotricuspid isthmus, business.industry, Treatment outcome, Incomplete block, Block (permutation group theory), General Medicine, medicine.disease, Internal medicine, Typical atrial flutter, medicine, Cardiology, Interval (graph theory), Cardiology and Cardiovascular Medicine, business, Cycle length, Atrial flutter
Abstract

Background: There is some disagreement concerning the minimal value of the interval between components of double potentials (DPs interval) that allows distinguishing complete and incomplete block in the cavotricuspid isthmus (CTI). Objectives: To assess clinical utility of the relationship between atrial flutter cycle length (AFL CL) and the DPs interval. Methods: Ablation of the CTI was performed in 87 patients during AFL (245 ± 40 ms). Subsequently, DPs were recorded during proximal coronary sinus pacing at sites close to a gap in the ablation line and after achievement of complete isthmus block. Results: We noted strong correlation between AFL CL and the DPs interval after achievement of isthmus block (r = 0.73). The mean DPs interval was 95.3 ± 18.3 ms (range 60–136 ms) and 123.3 ± 24.3 ms (range 87–211 ms) during incomplete and complete isthmus block, respectively (P < 0.001). When expressed as a percentage of AFL CL, this interval was 35.7 ± 3.5% AFL CL (range 28–40.2%) and 50.4 ± 6.9% AFL CL (range 39–72%) during incomplete and complete isthmus block, respectively (P < 0.001). A cutoff value of 40% of AFL CL identified CTI block with 96.7% sensitivity and 100% specificity. Conclusions: The interval between DPs after achievement of block in the CTI correlates with AFL CL. The DPs interval expressed as a percentage of AFL CL allows better distinguishing between complete and incomplete isthmus block compared to standard method based on milliseconds. The DPs interval below 40% of AFL CL indicates sites close to a gap in the ablation line. (PACE 2010; 33:1518–1527)

Published
2010
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50. Recurrence of RVOT PVCs with a Marked Shift of Its Exit Point. Gradual Elimination of Arrhythmogenic Focus by Multisite Approach

Author

Franciszek Walczak, Michał Orczykowski, Łukasz Szumowski, and Paweł Derejko M.D.

Subjects
medicine.medical_specialty, Focus (geometry), business.industry, medicine.medical_treatment, General Medicine, Ablation, medicine.anatomical_structure, Internal medicine, cardiovascular system, Cardiology, Medicine, In patient, Exit point, Outflow, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Rf ablation, Coronary sinus, Sinus (anatomy)
Abstract

We present a case of recurrent outflow tract arrhythmia despite repeated ablations. Premature ventricular contractions (PVCs) morphology suggested a right-sided focus. However, electrograms preceding PVCs were recorded from the right and left outflow tracts, distal coronary sinus, and right sinus of Valsalva. Arrhythmia was eliminated after radiofrequency (RF) applications delivered from different sites. We conclude that, in patients with recurrent outflow tract PVCs, mapping all the sites mentioned above may be necessary to find the earliest activation site and carry out successful ablation. In some patients, RF applications from multiple sites may be necessary to completely eliminate arrhythmia. (PACE 2012; 35:e6–e9)

Published
2010
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