“Ghost”, a Well-Known but Not Fully Explained Echocardiographic Finding during Transvenous Lead Extraction: Clinical Significance

Dorota Nowosielecka (), Wojciech Jacheć, Anna Polewczyk, Łukasz Tułecki, Paweł Stefańczyk and Andrzej Kutarski
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Dorota Nowosielecka: Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Wojciech Jacheć: 2nd Department of Cardiology, Faculty of Medical Sciences, Silesian Medical University, 41-800 Zabrze, Poland
Anna Polewczyk: Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
Łukasz Tułecki: Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Paweł Stefańczyk: Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Andrzej Kutarski: Department of Cardiology, Medical University, 20-059 Lublin, Poland

IJERPH, 2022, vol. 19, issue 19, 1-16

Abstract: “Ghosts” are fibrinous remnants that become visible during transvenous lead extraction (TLE). Methods: Data from transoesophageal echocardiography-guided TLE procedures performed in 1103 patients were analysed to identify predisposing risk factors for the development of so-called disappearing ghosts—flying ghosts (FG), or attached to the cardiovascular wall—stable ghosts (SG), and to find out whether the presence of ghosts affected patient prognosis after TLE. Results: Ghosts were detected in 44.67% of patients (FG 15.5%, SG 29.2%). The occurrence of ghosts was associated with patient age at first system implantation [FG (OR = 0.984; p = 0.019), SG (OR = 0.989; p = 0.030)], scar tissue around the lead (s) [FG (OR = 7.106; p < 0.001, OR = 1.372; p = 0.011), SG (OR = 1.940; p < 0.001)], adherence of the lead to the cardiovascular wall [FG (OR = 0.517; p = 0.034)] and the number of leads [SG (OR = 1.450; p < 0.002). The presence of ghosts had no impact on long-term survival after TLE in the whole study group [FG HR = 0.927, 95% CI (0.742–1.159); p = 0.505; SG HR = 0.845, 95% CI (0.638–1.132); p = 0.265]. Conclusions: The degree of growth and maturation of scar tissue surrounding the lead was the strongest factor leading to the development of both types of ghosts. The presence of either form of ghost did not affect long-term survival even after TLE indicated for infection.

Keywords: transvenous lead extraction; transoesophageal echocardiography; scar tissue; ghost (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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