Unusual presence of ‘ghosts’ following lead extraction for r
The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called ‘ghosts’. Their presence has been associated with cardiac device-related infective endocarditis or local device infection.

A 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500 mL of non-haemorrhagic fluid. The patient’s history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome.

Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall.

Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, the authors opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a ‘ghost’ was possible.

Learning points
• A persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described as echocardiographic tubular mobile masses called ‘ghosts’.

• This clinical case describes for the first time the presence of fibrin ‘ghosts’ even after a brief period from the implantation of a pacemaker, highlighting a non-exclusively infectious genesis.

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