Is it safe to cut pacing wires flush with the skin instead of removing them?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to cut the temporary epicardial pacing wires (TEPWs) flush with the patient's skin surface prior to discharge. Altogether 105 relevant papers were identified of which 13 case reports represented the best evidence to answer the question. The author, journal, date, country of publication, complications, the culprit TEPW and relevant outcomes are tabulated. All case reports demonstrated a wide spectrum of complications. Complications from a retained TEPW mainly arise after a long dormant period. A recent case report has demonstrated the herniation of intra-abdominal contents through a diaphragmatic defect created by the abandoned epicardial pacing wires after a few decades. In multiple case reports, the migration of TEPW was the culprit of serious complications. In two case reports, the TEPWs attached to the right chambers of the heart had migrated to the pulmonary artery via the right atrium and then the right ventricle. In one case report, a similar migration of the right ventricular TEPW to the right ventricular outflow track was observed. The TEPW migration was not limited to the right side of the heart, as in one case report the right atrial TEPW had migrated to the right carotid artery via the ascending aorta. A distant extravascular migration of TEPWs to the skin surface and intraperitoneal and pelvic cavities has also been reported. Retained TEPWs have also been reported to inflict complications locally. One case report has shown a large right-sided para-cardiac mass caused by a right atrial TEPW. In two other case reports, the bronchocutaneous fistula, lobar consolidation and bronchiectasis were the manifestations of a retained TEPW. We conclude that the retention of TEPW after cardiac surgery is not necessarily safe and may cause severe complications. We recommend that TEPWs should be completely removed when possible. If TEPWs are retained, this should be appropriately documented and the surgeon should be mindful of this when the patient presents with complications postoperatively.

Delayed granulomatous reaction and cutaneous fistula induced by retained electrodes from a cardiac pacemaker in a child

“…Long‐term complications may arise from abandoned pacing wires that lead to significant morbidity and that require additional surgery. Therefore, any retained materials should be documented in the patient's medical history . If skin lesions appear near a pacing device, especially if foreign material is seen on an ultrasound, it is important to avoid any uncontrolled traction procedures and to contact surgeons with experience in this area to ensure the proper management of these patients …”

“…The risk of complications related to the retained epicardial leads is generally considered to be low . In contrast, other authors recommend removing the epicardial wires when they are no longer needed due to the low risk of the procedure when compared to the potential benefits . As a result, there is not a clear consensus and this decision often requires an individual assessment.…”

“…7 In contrast, other authors recommend removing the epicardial wires when they are no longer needed due to the low risk of the procedure when compared to the potential benefits. 9 As a result, there is not a clear consensus and this decision often requires an individual assessment. Regardless of the choice, an operating room is required as with any surgical procedure, and complications may occur that could be life threatening.…”

Retained wire with intra-aortic migration presenting with hemoptysis

“…recurrent/persistent sepsis or pneumonia) [2]. As shown in this case, delayed migration can occur relatively rapidly once initiated and the presenting signs/symptoms can be very nonspecific.…”

Hemopericardium caused by a mobile retained epicardial pacing wire after ventricular septal defect repair

“…[2] Complications of a retained EPW include migration, infection, coronary artery compression, arrhythmia, graft injury, myocardial infarction, retroaortic abscess, aortic bleeding, hemopericardium, pneumopericardium, diaphragmatic hernia, bronchocutaneous fistula, or even colon perforation; migration is the most common complication. [3–10] …”