title: Chronic fibrous sheath mistaken for retained pacemaker product.
abstract: A 71-year-old man underwent implantation of a single-chamber system in 1988 for sinoatrial disease, which was then upgraded to dual-chamber 7 years later following recurrent syncope. He presented with pacemaker erosion but without clinical or laboratory evidence of infective endocarditis. The pacemaker system was uneventfully extracted 5 days later via a transfemoral approach using a needle-eye snare. A post-procedure trans-thoracic echocardiogram was performed, which demonstrated an echogenic structure in the right atrium-this was initially felt to be a retained fragment of pacing lead. A short-axis view of the tricuspid valve with a bright linear echo crossing is shown in Figure 1. However, a post-procedural chest X-ray confirmed the absence of any retained intra-cardiac lead. The reverberant cast-like structure noted is a heavily calcified fibrous sheath as the pacing leads were confirmed to be intact at the time of removal.
authors.affiliation: Department of Cardiology, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK. sheraz.nazir@doctors.org.uk
authors.forename: Sheraz A
authors.initials: SA
authors.lastname: Nazir
authors.forename: Lucy
authors.initials: L
authors.lastname: Hudsmith
authors.forename: James D
authors.initials: JD
authors.lastname: Newton
authors.forename: Tim R
authors.initials: TR
authors.lastname: Betts
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D002908:Chronic Disease; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*