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Background: The Amplatzer Amulet (St. Jude Medical, Minneapolis, MN, USA) is a second gen­eration Amplatzer device for left atrial appendage (LAA) occlusion (LAAO) for stroke prophylaxis in patients with atrial fibrillation. This research sought to assess the clinical performance of the Amplatzer Amulet device and in follow up for 12 months. Methods: In this single-center registry patients with atrial fibrillation and contraindication to oral anticoagulation underwent LAAO with the Amplatzer Amulet device. Follow-up was performed before discharge, by transesophageal echocardiography (TEE) after 6 weeks and telephone interview after 3, 6 and 12 months. Results: Between October 2014 and August 2015 50 patients (76.1 ± 8.3 years; 30 male) were en­rolled. Procedural success was achieved in 49 (98%) patients. Major periprocedural adverse events were observed in 4 (8%) of patients: 1 device embolization, 2 pericardial effusions requiring pericardiocente­sis and 1 prolonged hospital stay due to retropharyngeal hematoma from the TEE probe. Follow-up TEE was available in 38 of 50 patients showing complete LAA sealing in all. 2 device-related thrombi were also documented. At 12-month follow-up 7 patients had died unrelated to the device. Ischemic stroke occurred in 3 patients. According to neurological examination two were classified as microangiopathic and not cardio-embolic. The other one could not be classified. Bleeding complications (5 minor, 3 major) were documented in 8 patients. Conclusions: Although minimizing procedure-related complications remains challenging, LAAO with the Amplatzer Amulet device showed high procedural success and excellent LAA sealing. (Cardiol J 2017; 24, 2: 131–138)

Background Although magnetocardiography (MCG) has been proposed as a non-invasive technique with high accuracy for functional diagnosis of myocardial injury, the validation of MCG against fractional flow reserve FFR in diagnosing coronary artery disease (CAD) has not yet been established. The goal of the study was to determine the diagnostic accuracy of MCG versus invasively determined FFR in patients with suspected or known CAD. Methods Forty seven patients with suspected CAD (35 men; mean age 69 years) who underwent coronary angiography and FFR measurement were enrolled. FFR ≤ 0.8 was considered to indicate significant myocardial ischemia. The change of ST-segment fluctuation score from rest to stress was calculated from the MCG. In addition, two blinded cardiologists assessed MCG images that were visualized by post-processing method, bull's-eye mapping. Results The best cut-off value of the percent change of ST-segment fluctuation score was -39.0% with sensitivity of 86.7% and specificity of 73.9%. Sensitivity, specificity, diagnostic accuracy, and the area under the receiver-operator characteristics curve of bull's-eye mapping for the detection of significant CAD were 90.5%, 92.3%, 91.5%, and 0.914 on a patient basis and 90.0%, 93.8%, 92.3%, and 0.919 by coronary territory, respectively. Conclusions MCG accurately detects functionally significant CAD as defined by using FFR, provides an assessment of ischemic status in agreement with the change of ST-segment fluctuation score, and accurately localizes the ischemic territory in bull's eye mapping. Therefore, MCG may provide an incremental value for prediction of myocardial ischemia non-invasively and safely in clinical practice with fast examination time.

Die Indikation zur Implantation eines Kardioverter-Defibrillators (ICD) ist nicht nur zur Sekundarprophylaxe des plotzlichen Herztods durch Studienergebnisse gesichert, sondern aufgrund der Studienergebnisse von MADIT II, Companion und SCD-HeFT steigt zunehmend auch die Anzahl der ICD-Implantationen mit prophylaktischer Indikation. Der wichtigste klinische Parameter fur ein erhohtes Risiko des plotzlichen Herztods ist die eingeschrankte linksventrikulare Funktion (LVEF ≤ 35%). Bei der Auswahl der ICD-Gerate mussen die AV-Uberleitung, eine notwendige Vorhofstimulation und der Grad der Herzinsuffizienz berucksichtigt werden. Der Ein-Kammer-VVI-ICD reicht fur die primare Prophylaxe weitgehend aus. Wenn aber AV-Uberleitungsstorungen und Symptome einer Herzinsuffizienz mit verbreitertem QRS bestehen, muss die Implantation eines biventrikularen Defibrillators zur Stimulation und Resynchronisation der Herzkammern empfohlen werden. Die Indikation des Zweikammerdefibrillators beschrankt sich weitgehend auf Sinusknotenerkrankungen und Diskriminierungsvorteile bei langsamen ventrikularen Tachykardien.

Molds of the class of Oomycetes are of allergologic importance in special cases. However, probes are not commercially available for diagnostic purposes. Our case report is based on the medical history of a greenhouse worker who had atopic syndrome. He handled pure cultures of defined fungi and plants. A sensitization to pseudo mildew growing on grapevine (Plasmopara viticola) was found. Skin prick test and histamine release test results were positive when extract of P. viticola was used. Detection of IgE reactivities against pseudo mildew via binding tests, Western blot analysis, and isoelectric focusing immunoblot confirmed the diagnosis. To our knowledge these results demonstrate for the second time a sensitization to Oomycetes.