A 49-year-old man with a history of familial amyloidotic polyneuropathy was admitted to the hospital because of device-related endocarditis. He had undergone a liver transplant and placement of a single-chamber pacemaker 19 years earlier. After transvenous right ventricular lead extraction (LE), transthoracic echocardiography revealed a hyperechogenic, filiform, anomalous mass of 8 × 5 mm (Fig. 1, and see Videos 1 and 2 in Electronic Supplementary Material). The mass was located along the removed lead’s intracardiac route; one end of the mass was attached to the right ventricular wall and the other end was located below the tricuspid valve and had a very mobile tip. An interventional report and an X‑ray confirmed complete LE. The mass was interpreted as a thick, fibrous, tubular encasement of the lead that persisted after extraction, also known as ‘ghost’. A conservative approach was followed. Blood cultures were persistently negative, and the patient remained asymptomatic during subsequent follow-up.
Fig. 1 [Images not available. See PDF.]
Transthoracic echocardiography. a Four-chamber right-ventricle focused view showing hyperechogenic, filiform, anomalous mass (8 × 5 mm), with mobile tip curving inside tricuspid valve. b Four-chamber view showing attachments of mass to right ventricular wall and below tricuspid valve
The presence of ‘ghosts’ is associated with a poor prognosis after LE, but the best approach for patients with this finding remains unclear. To prevent complications such as recurrent infective endocarditis or embolic events, close follow-up is needed [1].
Conflict of interest
V. Neto, J. Santos, N. Craveiro, L. Santos and M. Correia declare that they have no competing interests.
References
1. Narducci, ML; Di Monaco, A; Pelargonio, G et al. Presence of ‘ghosts’ and mortality after transvenous lead extraction. Europace; 2017; 19, pp. 432-440. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27025772]
; Santos, J. 1 ; Craveiro, N. 1 ; Santos, L. 1 ; Correia, M. 1