Chronic fibrous sheath mistaken for retained pacemaker product

Area of Science:

• Cardiology
• Medical Devices

Background:

• A 71-year-old male with a history of sinoatrial disease received a pacemaker in 1988, upgraded to a dual-chamber system in 1995.
• The patient presented with pacemaker erosion, but without signs of infective endocarditis.

Observation:

• Pacemaker system extraction was performed via a transfemoral approach using a needle-eye snare.
• Post-procedure echocardiography revealed an echogenic structure in the right atrium, initially suspected to be a retained lead fragment.
• Chest X-ray confirmed the absence of retained intra-cardiac lead fragments.

Findings:

• The observed echogenic structure was identified as a heavily calcified fibrous sheath.
• The pacing leads were confirmed to be intact upon removal.

Implications:

• This case highlights the importance of differentiating between retained lead fragments and calcified sheaths using imaging modalities.
• Accurate diagnosis prevents unnecessary interventions and guides appropriate patient management following pacemaker lead extraction.