Presence of 'ghosts' and mortality after transvenous lead extraction

Maria Lucia Narducci, Antonio Di Monaco, Gemma Pelargonio, Emanuele Leoncini, Stefania Boccia, Roberto Mollo, Francesco Perna, Gianluigi Bencardino, Faustino Pennestrì, Giancarlo Scoppettuolo, Antonio Giuseppe Rebuzzi, Pasquale Santangeli, Luigi Di Biase, Andrea Natale, Filippo Crea

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


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'. Midterm 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.

Original languageEnglish (US)
Pages (from-to)432-440
Number of pages9
Issue number3
StatePublished - 2017
Externally publishedYes


  • Cardiac rhythm device
  • Infective endocarditis
  • Intracardiac echocardiography
  • Transvenous lead extraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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