Abstract
Abstract Introduction Prolonged antibiotic therapy and complete hardware removal are recommended in definite cardiac device–related infective endocarditis (CDRIE), as well as in presumably isolated pocket infection, in class I. A tubular mobile mass, known as ghost, that previously surrounded the lead can be detected by ultrasounds, in 8–14% of patients undergoing transvenous lead extraction (TLE). Case presentation: A 72–year–old man with ischemic cardiomyopathy is referred to our center due to a persistent fever. His medical history shows a previous extraction of CRT–D for infection of the left infraclavicular pocket, with a new implantation of CRT–P on the right side of the chest, in consideration of the recovery of the ejection fraction. At the entrance to the ward he has fever and inflammation‘s signs of the pocket of the generator, with positive blood cultures for Staphylococcus Aureus Methicillin resistant. A transesophageal echocardiography (TEE) excludes vegetations of valve systems and electrocatheters. Therefore, the patient begins antibiotic therapy and undergoes full extraction of the device (generator and leads). A post–operative transthoracic echocardiography shows the presence of a linear image of 2.5 cm in the right ventricle, seen as remnants of scar tissue surrounding the lead. ECG monitoring detects phases of BAV 2:1. Considering the high risk of infectious disease, a pacemaker leadless implantation is indicated. The surgery is postposted at the end of the 4 weeks of antibiotic therapy, checking blood cultures before implantation to reduce the residual infectious risk. Discussion The persistence of fibrous residues after TLE has been variously described in recent years, but it is unclear whether these are predictors of increased mortality. The current guidelines on the therapeutic management of patients with infectious endocarditis and pacemaker dependency do not indicated the timing of reimplantation, in a potentially infectious ghost setting. Clinical co–morbidities play a crucial role in the prognosis of patients, especially when combined with systemic infections. Conclusion An echocardiographic follow–up is recommended to detect ghost disappearance in patients undergoing explant due to a related device infection. In fact, a rapid fibrin dissolution process usually takes place when the thrombogenic stimulus is removed.
Published Version
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