Key result
The presence of either flying ghosts (HR 0.927) or stable ghosts (HR 0.845) did not significantly affect long-term survival after transvenous lead extraction.
Why the study?
Predisposing risk factors for flying ghosts and stable ghosts during TLE, and whether ghosts affect prognosis after TLE, were not fully explained.
Does the presence of echocardiographic 'ghosts' affect long-term survival in patients undergoing transvenous lead extraction?
Observational (n=1,103)
No
Does the presence of echocardiographic 'ghosts' affect long-term survival in patients undergoing transvenous lead extraction?
The presence of echocardiographic 'ghosts' (fibrinous remnants) during transvenous lead extraction is a common phenomenon related to scar tissue and implant duration, but it does not negatively impact long-term survival.
“Ghosts” are fibrinous remnants that become visible during transvenous lead extraction (TLE). Methods: Data from transoesophageal echocardiography-guided TLE procedures performed in 1103 patients were analysed to identify predisposing risk factors for the development of so-called disappearing ghosts—flying ghosts (FG), or attached to the cardiovascular wall—stable ghosts (SG), and to find out whether the presence of ghosts affected patient prognosis after TLE. Results: Ghosts were detected in 44.67% of patients (FG 15.5%, SG 29.2%). The occurrence of ghosts was associated with patient age at first system implantation [FG (OR = 0.984; p = 0.019), SG (OR = 0.989; p = 0.030)], scar tissue around the lead (s) [FG (OR = 7.106; p < 0.001, OR = 1.372; p = 0.011), SG (OR = 1.940; p < 0.001)], adherence of the lead to the cardiovascular wall [FG (OR = 0.517; p = 0.034)] and the number of leads [SG (OR = 1.450; p < 0.002). The presence of ghosts had no impact on long-term survival after TLE in the whole study group [FG HR = 0.927, 95% CI (0.742–1.159); p = 0.505; SG HR = 0.845, 95% CI (0.638–1.132); p = 0.265]. Conclusions: The degree of growth and maturation of scar tissue surrounding the lead was the strongest factor leading to the development of both types of ghosts. The presence of either form of ghost did not affect long-term survival even after TLE indicated for infection.
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Nowosielecka et al. (2022) conducted an observational in Patients undergoing transvenous lead extraction (TLE) (n=1,103). Presence of echocardiographic 'ghosts' (fibrinous remnants) vs. Absence of ghosts was evaluated on Long-term survival after TLE (HR 0.927, 95% CI 0.742-1.159, p=0.505). The presence of either flying ghosts (HR 0.927) or stable ghosts (HR 0.845) did not significantly affect long-term survival after transvenous lead extraction.
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