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 journalArticle

13 Citations (Scopus)

Abstract

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
JournalEuropace
Volume19
Issue number3
DOIs
StatePublished - 2017
Externally publishedYes

Fingerprint

Mortality
Echocardiography
Equipment and Supplies
Infection
Transesophageal Echocardiography
Endocarditis
Lead
Morbidity

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Narducci, M. L., Di Monaco, A., Pelargonio, G., Leoncini, E., Boccia, S., Mollo, R., ... Crea, F. (2017). Presence of 'ghosts' and mortality after transvenous lead extraction. Europace, 19(3), 432-440. https://doi.org/10.1093/europace/euw045

Presence of 'ghosts' and mortality after transvenous lead extraction. / Narducci, Maria Lucia; Di Monaco, Antonio; Pelargonio, Gemma; Leoncini, Emanuele; Boccia, Stefania; Mollo, Roberto; Perna, Francesco; Bencardino, Gianluigi; Pennestrì, Faustino; Scoppettuolo, Giancarlo; Rebuzzi, Antonio Giuseppe; Santangeli, Pasquale; Di Biase, Luigi; Natale, Andrea; Crea, Filippo.

In: Europace, Vol. 19, No. 3, 2017, p. 432-440.

Research output: Contribution to journalArticle

Narducci, ML, Di Monaco, A, Pelargonio, G, Leoncini, E, Boccia, S, Mollo, R, Perna, F, Bencardino, G, Pennestrì, F, Scoppettuolo, G, Rebuzzi, AG, Santangeli, P, Di Biase, L, Natale, A & Crea, F 2017, 'Presence of 'ghosts' and mortality after transvenous lead extraction', Europace, vol. 19, no. 3, pp. 432-440. https://doi.org/10.1093/europace/euw045
Narducci ML, Di Monaco A, Pelargonio G, Leoncini E, Boccia S, Mollo R et al. Presence of 'ghosts' and mortality after transvenous lead extraction. Europace. 2017;19(3):432-440. https://doi.org/10.1093/europace/euw045
Narducci, Maria Lucia ; Di Monaco, Antonio ; Pelargonio, Gemma ; Leoncini, Emanuele ; Boccia, Stefania ; Mollo, Roberto ; Perna, Francesco ; Bencardino, Gianluigi ; Pennestrì, Faustino ; Scoppettuolo, Giancarlo ; Rebuzzi, Antonio Giuseppe ; Santangeli, Pasquale ; Di Biase, Luigi ; Natale, Andrea ; Crea, Filippo. / Presence of 'ghosts' and mortality after transvenous lead extraction. In: Europace. 2017 ; Vol. 19, No. 3. pp. 432-440.
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AU - Di Monaco, Antonio

AU - Pelargonio, Gemma

AU - Leoncini, Emanuele

AU - Boccia, Stefania

AU - Mollo, Roberto

AU - Perna, Francesco

AU - Bencardino, Gianluigi

AU - Pennestrì, Faustino

AU - Scoppettuolo, Giancarlo

AU - Rebuzzi, Antonio Giuseppe

AU - Santangeli, Pasquale

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Crea, Filippo

PY - 2017

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N2 - 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.

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KW - Cardiac rhythm device

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