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

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.