A Novel Clinical Perspective on New Masses after Lead Extraction (Ghosts) by Means of Intracardiac Echocardiography
Abstract
:1. Introduction
2. Methods
2.1. Clinical Management
2.2. Intracardiac Echocardiography
2.2.1. Before Extraction
2.2.2. After the Extraction
2.3. Extraction Procedure
2.4. Transesophageal Echocardiography
2.5. End Points
2.6. Clinical Follow-up
2.7. Statistical Analysis
3. Results
3.1. Pre-extraction
3.2. Post-extraction ICE
3.3. Prognostic Impact of Ghosts
4. Discussion
4.1. Fibrosis Involving Leads
4.2. Nature of the Ghost
4.3. Septic Risk Connected to Ghost
4.4. Previous Studies
4.5. Clinical Implication
4.6. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Demographic and clinical variables | Data |
---|---|
Enrolled patients, # | 40 |
Age, years | 75 ± 11 |
Gender | |
Males, # | 33 |
Females, # | 7 |
BMI | 27 ± 5 |
Chronic RF, # (%) | 15 (37%) |
Diabetes, # (%) | 14 (35%) |
Hypertension, # (%) | 35 (87%) |
COPD, # (%) | 9 (22%) |
LVEF,% | 46 |
GFR, mL/min/1.73 m2 | 73 ± 23 |
Number of leads removed during each procedure | 2 ± 0.7 |
Atrial leads removed overall, # (%) | 33 (85%) |
Ventricular leads removed overall, # (%) | 36 (95%) |
CS leads removed overall, # (%) | 9 (23%) |
Time from first implantation (m) | 113 ± 70 |
Time from last operation (m) | 28 ± 28 |
Variables | No TL/FAC Group (n = 15) | TL/FAC Group (n = 25) | Odds Ratio (95% CI) | p-Value | |
---|---|---|---|---|---|
Age | 78 ± 8 | 74 ± 12 | - | ns | |
Sex, #pt (%) | male | 12 (80.0) | 21 (84.0) | ||
female | 3 (20.0) | 4 (16.0) | ns | ||
BMI | 25.94 ± 3.30 | 27.92 ± 5.91 | - | ns | |
Diabetes, #pt (%) | - | 12 (80.0) | 14 (56.0) | 1 | |
+ | 3 (20.0) | 11 (44.0) | 3.14 (0.70–14) | =0.12 | |
EF (%) | 47 ± 12 | 45 ± 11 | - | ns | |
CRF, #pt (%) | - | 9 (60.0) | 16 (64.0) | 1 | |
+ | 6 (40.0) | 9 (36.0) | 0.8 (0.22–3.1) | ns | |
Pocket culture positive, #pt (%) | - | 0 (0) | 10 (40) | 1 | |
+ | 15(100) | 15 (60) | 0.04(0.002–0.9) | =0.04 | |
Local device infection, #pt (%) | - | 0 (0) | 7 (28) | 1 | |
+ | 15 (100) | 18 (72) | 0.07(0.004–1.5) | =0.09 | |
Veg by ICE, #pt (%) | - | 7 (47) | 6 (24) | 1 | |
+ | 8 (53) | 19 (76) | 2.7(0.7–10) | ns | |
CRP (mg/L) | 9.07 ± 10.37 | 17.83 ± 31.06 | - | ns | |
White cells (count) | 5.77 ± 1.51 | 7.52 ± 2.40 | - | <0.05 | |
ESR (mm/h) | 29.33 ± 22 | 29.88 ± 22.47 | - | ns | |
Number of leads | 2.22 ± 0.6 | 2.13 ± 0.3 | - | ns | |
Implantation time (months) | 77 ± 61 | 134 ± 67 | - | <0.05 |
Variables | No Ghost Group (n = 16) | Ghost Group (n = 24) | OR (95% CI) | p-Value | |
---|---|---|---|---|---|
Patient-related factors | |||||
Age | 79 ± 9 | 73± 12 | - | ns | |
Sex, # (%) | male | 13 (81.2%) | 20 (83.3%) | ||
female | 3 (18.8%) | 4 (16.7%) | ns | ||
BMI | 25.91 ± 3.19 | 28.03 ± 6.01 | - | ns | |
Duke crit, # (%) | Possible endc | 5 (31.2%) | 5 (20.8%) | - | |
Definite endc (2 criteria) | 9 (56.2%) | 13 (54.2%) | - | ||
Definite endc (>2 criteria) | 2 (12.5%) | 6 (25%) | - | ns | |
LVEF | 47 ± 12 | 45 ± 12 | - | ns | |
CRF, # (%) | - | 10 (62.5%) | 15 (62.5%) | 1 | |
+ | 6 (37.5%) | 9 (37.5%) | 1.2(0.27–3.22) | ns | |
Diabetes, # (%) | - | 13 (81%) | 13 (54%) | 1 | |
+ | 3 (18%) | 11 (46%) | 3.7(0.82–16.3) | =0.08 | |
Infectious factors | |||||
CRP (mg/L) | 9.26 ± 10.04 | 18.06 ± 31.7 | - | ns | |
WBC (count*1000) | 5.98 ± 1.68 | 7.45 ± 2.43 | - | <0.05 | |
ESR (mm/h) | 29.50 ± 21.27 | 29.79 ± 22.9 | - | ns | |
Fever, # (%) | - | 12 (75%) | 18 (75%) | 1 | |
+ | 4 (25%) | 6 (25%) | 1.0(0.2–4.32) | ns | |
Local device infection, # (%) | - | 0 (0%) | 7 (29%) | 1 | |
+ | 16 (100%) | 17 (71%) | 0.07(0.003–1.78) | ns | |
Pocket culture positive, # (%) | - | 0 (0%) | 10 (42%) | 1 | |
+ | 16 (100%) | 14 (58.3%) | 0.04(0.002–.078) | <0.05 | |
Lead tip culture* positive, #(%) | - | 16 (100%) | 19 (79%) | 1 | |
+ | 0 (0%) | 5 (21%) | 9.3(0.5–181) | ns | |
BC pre-extraction positive, #(%) | - | 11 (69%) | 16 (67%) | 1 | |
+ | 5 (31%) | 8 (33%) | 2.1(0.08–54.9) | ns | |
BC post-extraction positive, #(%) | - | 16 (100%) | 23 (96%) | 1 | |
+ | 0 (0%) | 1 (4.2%) | 2.1(0.08–54.9) | ns | |
Endocarditis Vegetation by ICE, # (%) | - | 8 (50%) | 5 (21%) | 1 | |
+ | 8 (50%) | 19 (79%) | 2.7(0.90–8.1) | =0.073 | |
Lead-related factors | |||||
Number of leads | 2.25 ± 0.93 | 2.08 ± 0.58 | ns | ||
lead implantation time (m) | 78 ± 59 | 135 ± 68 | <0.05 | ||
Thickened lead, # (%) | - | 15 (94%) | 0 (0%) | 1 | |
+ | 1 (6.2%) | 24 (100%) | 506(19–13,324) | <0.0001 | |
FAC by ICE, # (%) | - | 16 (100%) | 12 (50%) | 1 | |
+ | 0 (0%) | 12 (50%) | 33(1.8–612) | =0.002 | |
Type of device, # (%) | PM | 8 (37%) | 14 (58%) | ||
ICD | 10 (62%) | 10 (42%) | ns |
Pt No | Age(years)/Gender | Type of Device | Heart Disease | LV EF | Complication of Extraction | Ghost Presence | Ghost Max Length (mm) | Days after Explantation, Cause of Death |
---|---|---|---|---|---|---|---|---|
2 | 76/M | ICD | Ischemic DCM | 27% | - | no | - | 62, Acute HF |
4 | 78/M | ICD | Ischemic DCM | 25% | - | yes | 8 | 20, ARDS |
12 | 49/F | PM | Infiltrative CM | 45% | - | yes | 7 | 35, MOF |
24 | 81/M | ICD | Ischemic DCM | 30% | - | no | - | 81, Acute HF |
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Caiati, C.; Luzzi, G.; Pollice, P.; Favale, S.; Lepera, M.E. A Novel Clinical Perspective on New Masses after Lead Extraction (Ghosts) by Means of Intracardiac Echocardiography. J. Clin. Med. 2020, 9, 2571. https://doi.org/10.3390/jcm9082571
Caiati C, Luzzi G, Pollice P, Favale S, Lepera ME. A Novel Clinical Perspective on New Masses after Lead Extraction (Ghosts) by Means of Intracardiac Echocardiography. Journal of Clinical Medicine. 2020; 9(8):2571. https://doi.org/10.3390/jcm9082571
Chicago/Turabian StyleCaiati, Carlo, Giovanni Luzzi, Paolo Pollice, Stefano Favale, and Mario Erminio Lepera. 2020. "A Novel Clinical Perspective on New Masses after Lead Extraction (Ghosts) by Means of Intracardiac Echocardiography" Journal of Clinical Medicine 9, no. 8: 2571. https://doi.org/10.3390/jcm9082571