Echocardiographic assessment of residuals after transvenous intracardiac lead extraction

Detection of residual fibrotic tissue, called ghosts, after lead extraction is a new phenomenon in cardiology. This paper aims at describing the phenomenon of ghosts and determining their characteristic features. The study group consisted of 580 consecutive patients who underwent transvenous lead extraction (TLE) due to local infection, endocarditis and a superfluous lead. Each patient was clinically examined with the application of transthoracic echocardiography and transesophageal echocardiography directly before and after TLE. In the study population ghosts were detected in 110 patients (19%), and in 470 cases (81%) fibrotic tissue residuals were not found. Ghosts were most often located along the originally implanted lead's route. Longer ghosts were found after the removal of cardiac resynchronization therapy (CRT) and dual chamber pacing (DDD) devices. The local infection and infective endocarditis are associated with a larger number of ghosts revealed after the removal procedure (p = 0.006). The type of the implanted device: CRT/ICD/double chamber pacemaker/single chamber pacemaker, similar to the number of leads, did not impact on the number of the detected ghosts. The relationship between abrasions of the leads and the presence of ghosts proved significant, however (p = 0.043). TLE is associated with the presence of fibrotic tissue residuals in approx. 19% of patients. Indications for lead extraction due to local infection and endocarditis yielded significantly more cases of ghosts than in the entire patient population. The presence of abrasions is a good predictor for the presence of ghosts on the leads.