This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Le Dolley, Y. Articles by Habib, G. Search for Related Content PubMed Articles by Le Dolley, Y. Articles by Habib, G.

Diagnosis of Cardiac Device–Related Infective Endocarditis After Device Removal

Yvan Le Dolley, MD^_*, Franck Thuny, MD^_*, Julien Mancini, MD, PhD^_*, Jean-Paul Casalta, MD, Alberto Riberi, MD^_*, Frédérique Gouriet, MD, Emilie Bastard, MD^_*, Sebastien Ansaldi, MD^_*, Frederic Franceschi, MD^_*, Sebastien Renard, MD^_*, Sebastien Prevot, MD^_*, Roch Giorgi, MD, PhD^_*, Laurence Tafanelli, MD^_*, Jean-François Avierinos, MD^_*, Didier Raoult, MD, PhD, Jean-Claude Deharo, MD^_*, Gilbert Habib, MD^_*,_*

^_* Department of Cardiology, La Timone Hospital, Marseille, France
Department of Infectious Disease, La Timone Hospital, Marseille, France

^_* Reprint requests and correspondence: Dr. Gilbert Habib, Département de Cardiologie, Hôpital de la Timone, Boulevard Jean Moulin, 13005 Marseille, France (Email: gilbert.habib{at}free.fr).

Objectives: We sought to determine the incidence, diagnostic value, and outcome of intracardiac masses observed by echocardiography after device removal. We hypothesized that these "ghosts" of leads could be associated with the diagnosis of cardiac device–related infective endocarditis (CDRIE).

Background: The echocardiographic appearance of residual floating masses in the right atrium after removal of permanent pacemakers and implantable cardioverter-defibrillators was recently described. However, the significance of these ghosts and their relationship with CDRIE are unknown.

Methods: The pre-operative clinical, microbiological, and echocardiographic conditions; the indication; and the removal technique were analyzed in a retrospective cohort including all consecutive patients who underwent percutaneous lead removal. Three groups were formed according to the final diagnosis: CDRIE, local device infection, and noninfectious indications. The incidence of ghosts was compared among the 3 groups. All clinical, infectious, and extraction-related factors were studied for their association with ghosts. All patients with ghosts were followed after hospitalization.

Results: Two hundred twelve patients underwent lead removal. Ghosts were observed in 17 patients (8% incidence), including 14 (16%) of 88 patients with CDRIE and 3 (5%) of 59 patients with local device infection. Ghosts were never observed among the remaining 65 noninfected patients. A significant association was found between CDRIE and the presence of a ghost (odds ratio: 7.63, 95% confidence interval: 2.12 to 27.45, p = 0.001). At 3 months, 2 patients with ghosts died suddenly, 2 underwent surgery, and 1 had a pulmonary embolism.

Conclusions: Ghosts are observed in 8% of patients after percutaneous device extraction. Their presence is suggestive of device infection and seems to be associated with the diagnosis of CDRIE. The prognostic significance of such findings needs further investigation.

Key Words: defibrillator • endocarditis • lead infection • pacemaker

Abbreviations and Acronyms   CDRIE = cardiac device–related infective endocarditis   ICD = implantable cardioverter-defibrillator   LDI = local device infection   TTE = transthoracic echocardiography