title: Diagnosis of cardiac device-related infective endocarditis after device removal.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, La Timone Hospital, Marseille, France.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Le Dolley
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gouriet
authors.forename: Emilie
authors.initials: E
authors.lastname: Bastard
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ansaldi
authors.forename: Frederic
authors.initials: F
authors.lastname: Franceschi
authors.forename: Sebastien
authors.initials: S
authors.lastname: Renard
authors.forename: Sebastien
authors.initials: S
authors.lastname: Prevot
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Laurence
authors.initials: L
authors.lastname: Tafanelli
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult