A Ghost Left Behind After Transvenous Lead Extraction: A Finding to be Feared

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Transvenous lead extraction (TLE) for infective endocarditis can leave behind fibrinous remnants known as "ghosts".
• These remnants may pose risks for future complications and infection recurrence.
• This case report emphasizes identifying and monitoring these post-extraction phenomena.

Observation:

• A 72-year-old male with multiple cardiac device implantations and a history of methicillin-resistant Staphylococcus aureus bacteremia underwent TLE for infective endocarditis.
• Post-TLE, a 1.3 cm mobile echo-dense "ghost" was identified in the right atrium via transesophageal echocardiogram.
• The patient received a leadless pacemaker (LP) and later a subcutaneous implantable cardioverter defibrillator (SICD).

Findings:

• The identified "ghost" resolved spontaneously within 3 months, as confirmed by echocardiography.
• No evidence of infection recurrence was noted at the 1-year follow-up.
• The patient successfully received the planned SICD implantation.

Implications:

• The presence of "ghosts" after TLE may be associated with adverse outcomes and infection recurrence.
• Diligent monitoring and serial echocardiography are recommended for patients with post-TLE "ghosts".
• Optimal management strategies for these remnants require further investigation.