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Case Reports
. 2018 Nov 26;2(4):yty127.
doi: 10.1093/ehjcr/yty127. eCollection 2018 Dec.

Unusual presence of 'ghosts' following lead extraction for recurrent reactive pericarditis: a case report

Riccardo Bentivegna  1 , Giuseppe Cattafi  2 , Cristina Giannattasio  2 , Antonella Moreo  2
Affiliations
Case Reports

Unusual presence of 'ghosts' following lead extraction for recurrent reactive pericarditis: a case report

Riccardo Bentivegna et al. Eur Heart J Case Rep. .

Abstract

Background: The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called 'ghosts'. Their presence has been associated with cardiac device-related infective endocarditis or local device infection, but to the best of our knowledge, this is the first case where 'ghosts' have been reported among non-infected patients.

Case summary: We present a case of a 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500 mL of non-haemorrhagic fluid. The patient's history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome. Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall. Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, we opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a 'ghost' was possible.

Discussion: This is the first clinical case describing the presence of fibrin 'ghosts' sometime after the implantation of a pacemaker, highlighting a non-exclusively infectious genesis, and emphasizing the importance of TOE for the early detection of this post-extraction complication and its monitoring.

Keywords: Cardiac rhythm device; Case report; Ghosts; Recurrent pericarditis; Transvenous lead extraction.

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Figures

Figure 1
Figure 1
Chest X-rays before pericardiocentesis (A) and before lead extraction (B).
Figure 2
Figure 2
Long floating masses clearly visible (arrow), during extraction, at two-dimensional transoesophageal echocardiography in mid-oesophageal bicaval view (A); three-dimensional transoesophageal echocardiography imaging in two successive frames of the same cardiac cycle (B and C).
Figure 3
Figure 3
Atrial and ventricular leads after their extraction.
See this image and copyright information in PMC

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