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European Journal of Echocardiography Advance Access originally published online on January 15, 2009
European Journal of Echocardiography 2009 10(2):343; doi:10.1093/ejechocard/jen330
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Chronic fibrous sheath mistaken for retained pacemaker product

Sheraz A. Nazir*, Lucy Hudsmith, James D. Newton and Tim R. Betts

Department of Cardiology, Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK

Received 11 July 2008; accepted after revision 17 July 2008; online publish-ahead-of-print 15 January 2009.

* Corresponding author. E-mail address: sheraz.nazir{at}doctors.org.uk


  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.

Keywords: Retained pacemaker wire; Extraction; Cast; Fibrous sheath


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