Acute cardiac tamponade following the removal of temporary epicardial pacemaker wires after open heart surgery

Baldwin, Brian J.; Dorney, Edward R.

doi:10.1097/00000441-197105000-00002

Cited by 12 publications

(6 citation statements)

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“…[4][5][6]9,10 Patients with chest pressure, dizziness, and cold and clammy skin also had hypotension, as did one of the 2 patients with mental status changes. Thus, many of the nonbleeding and nondyspnea factors that were identified could reflect a typical response to a new-onset low-cardiac-output state.…”

Section: Median Unitsmentioning

confidence: 96%

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Cardiac Tamponade After Removal of Temporary Pacer Wires

Mahon

Bena

Morrison

et al. 2012

American Journal of Critical Care

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Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

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Section: Median Unitsmentioning

confidence: 96%

“…In addition, the patient's blood pressure decreased to 70/60 mm Hg and the pulse increased to 130 beats per minute. 5 In the third case of CABG, after atrial epicardial wires were removed, the patient was found to be unresponsive and in bradycardia; however, no time frame was provided. 6 The true incidence of cardiac tamponade after TPWR is unknown.…”

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confidence: 99%

Cardiac Tamponade After Removal of Temporary Pacer Wires

Mahon

Bena

Morrison

et al. 2012

American Journal of Critical Care

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“…The earliest reports of complications regarding TEPWs date back to 1971 11. Complications relate primarily to insertion, removal and transmyocardial migration of the TEPWs.…”

Section: Discussionmentioning

confidence: 99%

The catastrophic journey of a retained temporary epicardial pacemaker wire leading toEnterococcus faecalisendocarditis and subsequent stroke

Dyal

Sehgal

2015

BMJ Case Reports

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SUMMARYA 52-year-old man underwent triple coronary artery bypass graft (CABG). Three months later, he presented to the emergency room with dizziness and left-sided weakness. Workup revealed right frontal parenchymal haemorrhage; also, two retained temporary epicardial pacemaker wires (TEPW) from his previous CABG were observed, one of which had significantly migrated. One wire was found in the soft tissues below the heart; the other transversed the mediastinum from the expected location of the right atrium, perforating the right atrial appendage, entering the lumen of the ascending aorta and coursing into the mid-descending aorta. There were vegetations (Enterococcus spp) on the migrated TEPW and aortic valve, aortic valve endocarditis and aortic regurgitation. In summary, we suspect the migrated TEPW may be the source of bacteria that seeded the aortic valve, causing endocarditis and contributing to the patient's subsequent stroke. Management involved two 6-week antibiotic courses, wire-extraction, aortic valve replacement and redo CABG. BACKGROUND

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“…Meier et al described a case of ventricular tachycardia as a primary manifestation of the transmyocardial migration of the epicardial wire, 2 years after the index cardiac surgery 2 . Other case reports describe epicardial lead migration leading to cardiac tamponade and hemothorax as well as damage to coronary arteries, pericardium, graft vessels, pleura, and the aorta 3,4 . Still, other sites of migration include pulmonary bronchi and abdominal viscera 5,6 .…”

Section: Discussionmentioning

confidence: 99%

Transmyocardial Voyage of a Temporary Epicardial Lead: An Unusual Long‐Term Complication

Sheikh

Bruhl

Omer

et al. 2011

Pacing Clinical Electrophis

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Although the majority of temporary epicardial leads used during cardiac surgery are removed in the perioperative period, occasionally, the wires are cut and allowed to retract into the subcutaneous tissue. Complications arising from such retained epicardial wires are rare. We present a case of transmyocardial migration of a retained epicardial wire through the right ventricular myocardium into the pulmonary artery in a patient who had undergone coronary artery bypass graft surgery 13 years ago. We describe the presentation and successful management of this case.

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Acute cardiac tamponade following the removal of temporary epicardial pacemaker wires after open heart surgery

Cited by 12 publications

References 0 publications

Cardiac Tamponade After Removal of Temporary Pacer Wires

Cardiac Tamponade After Removal of Temporary Pacer Wires

The catastrophic journey of a retained temporary epicardial pacemaker wire leading toEnterococcus faecalisendocarditis and subsequent stroke

Transmyocardial Voyage of a Temporary Epicardial Lead: An Unusual Long‐Term Complication

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