Document Detail

Diagnosis of cardiac device-related infective endocarditis after device removal.
MedLine Citation:
PMID:  20633844     Owner:  NLM     Status:  MEDLINE    
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.
Yvan Le Dolley; Franck Thuny; Julien Mancini; Jean-Paul Casalta; Alberto Riberi; Frédérique Gouriet; Emilie Bastard; Sebastien Ansaldi; Frederic Franceschi; Sebastien Renard; Sebastien Prevot; Roch Giorgi; Laurence Tafanelli; Jean-François Avierinos; Didier Raoult; Jean-Claude Deharo; Gilbert Habib
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  3     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-16     Completed Date:  2010-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  673-81     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Cardiology, La Timone Hospital, Marseille, France.
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MeSH Terms
Aged, 80 and over
Chi-Square Distribution
Defibrillators, Implantable / adverse effects*
Device Removal*
Echocardiography, Transesophageal*
Endocarditis / epidemiology,  microbiology,  therapy,  ultrasonography*
Logistic Models
Middle Aged
Odds Ratio
Pacemaker, Artificial / adverse effects*
Predictive Value of Tests
Prosthesis-Related Infections / epidemiology,  microbiology,  therapy,  ultrasonography*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult

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