The presence of a post-procedural 'ghost' after transvenous lead extraction was associated with significantly higher mid-term mortality compared to its absence (28% vs. 5%; HR 3.47, 95% CI 1.18-10.18).
Cohort (n=217)
Does the presence of a post-procedural 'ghost' on echocardiography predict mortality in patients undergoing transvenous lead extraction?
The presence of a 'ghost' mass on echocardiography after transvenous lead extraction is a strong independent predictor of mid-term mortality, highlighting a high-risk subgroup requiring close clinical surveillance.
Effect estimate: HR 3.47 (95% CI 1.18-10.18)
Absolute Event Rate: 28% vs 5%
p-value: p=0.002
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.
Narducci et al. (Tue,) conducted a cohort in Patients undergoing transvenous lead extraction (TLE) (n=217). Presence of post-procedural 'ghost' vs. Absence of post-procedural 'ghost' was evaluated on Mid-term mortality (HR 3.47, 95% CI 1.18-10.18, p=0.002). The presence of a post-procedural 'ghost' after transvenous lead extraction was associated with significantly higher mid-term mortality compared to its absence (28% vs. 5%; HR 3.47, 95% CI 1.18-10.18).