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. 2017 Mar 1;19(3):432-440.
doi: 10.1093/europace/euw045.

Presence of 'ghosts' and mortality after transvenous lead extraction

Maria Lucia Narducci  1 , Antonio Di Monaco  1 , Gemma Pelargonio  1 , Emanuele Leoncini  2 , Stefania Boccia  2 , Roberto Mollo  1 , Francesco Perna  1 , Gianluigi Bencardino  1 , Faustino Pennestrì  1 , Giancarlo Scoppettuolo  3 , Antonio Giuseppe Rebuzzi  1 , Pasquale Santangeli  4 , Luigi Di Biase  4 , Andrea Natale  4 , Filippo Crea  1
Affiliations

Presence of 'ghosts' and mortality after transvenous lead extraction

Maria Lucia Narducci et al. Europace. .

Abstract

Aims: The number of cardiovascular implantable electronic devices has increased progressively, leading to an increased need for transvenous lead extraction (TLE) due to device infections. Previous studies described 'ghost' as a post-removal, new, tubular, mobile mass detected by echocardiography following the lead's intracardiac route in the right-sided heart chambers, associated with diagnosis of cardiac device-related infective endocarditis. We aimed to analyse the association between 'ghosts' assessed by transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) and mortality in patients undergoing TLE.

Methods and results: We prospectively enrolled 217 patients (70 ± 13 years; 164 males) undergoing TLE for systemic infection (139), local device infection (67), and lead malfunction (11). All patients underwent TEE before and 48 h after TLE and ICE during TLE. Patients were allocated to two groups: either with (Group 1) or without (Group 2) post-procedural 'ghost'. Mid-term clinical follow-up was obtained in all patients (11 months, IQR 1-34 months). We identified 30 (14%) patients with 'ghost', after TLE. The significant predictors of 'ghost' were Charlson co-morbidity index (HR = 1.24, 95% CI 1.04-1.48, P = 0.03) and diagnosis of endocarditis assessed by ICE (HR = 1.82, 95% CI 1.01-3.29, P = 0.04). Mortality was higher in Group 1 than in Group 2 (28 vs. 5%; log-rank P < 0.001). Independent predictors of mid-term mortality were the presence of 'ghost' and systemic infection as the clinical presentation of device infection (HR = 3.47, 95% CI 1.18-10.18, P = 0.002; HR = 3.39, 95% CI 1.15-9.95, P = 0.001, respectively).

Conclusion: The presence of 'ghost' could be an independent predictor of mortality after TLE, thus identifying a subgroup of patients who need closer clinical surveillance to promptly detect any complications.

Keywords: Cardiac rhythm device; Infective endocarditis; Intracardiac echocardiography; Transvenous lead extraction.

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