Migration of a retained temporary epicardial pacing wire into an abdominal aortic aneurysm: Figure 1:

Abstract

A 69-year old male was referred to our hospital for the treatment of coronary artery disease. Preoperative computed tomography (CT) revealed an abdominal aortic aneurysm (AAA) and a giant tumour of the left kidney. He underwent off-pump coronary artery bypass grafting (OPCAB) prior to aneurysmectomy and nephrectomy. Temporary epicardial pacing wires (TEPWs) were placed on the right atrium and right ventricle. The bipolar ventricular wire was removed and the unipolar atrial wire was cut flush with the skin surface on postoperative day 5. CT 7 days after the OPCAB procedure revealed a retained TEPW sutured to the right atrial wall. One month later, the patient underwent a repair of the AAA and left nephrectomy. We found that a TEPW had migrated inside the AAA intraoperatively. The retained TEPW was thus no longer observed on postoperative CT. Migration of the atrial pacing wire through the aortic lumen was suspected, although the detailed mechanism is unknown. This is the first reported case of a migrated temporary pacing wire into the aorta under noninfectious conditions.

Clinical and mechanical factors associated with the removal of temporary epicardial pacemaker wires after cardiac surgery

“…Pacer wires were clipped at the skin in 6.6 % of our patients. Problems related to wire retention include late patient discomfort, wire migration [ 3 ], organ herniation [ 9 ]and late infection [ 2 ]. Further, patients may be unable to undergo some forms of magnetic resonance imaging with higher magnetic fields (3 Tesla) due to concerns of heat transmission and cardiac damage [ 10 ].…”

“…In the majority of cases, this procedure is well-tolerated by the patient however infrequently complications may occur such as late tamponade. Further, failure to remove a temporary wire completely has been associated with late complications such as infection [ 2 ] and wire migration [ 3 ].…”

Safety of temporary pacemaker wires

“…26 Migrated temporary pacemaker wires on the RA, which were cut and left in situ due to resistance, into the abdominal aorta one month after off-pump coronary artery bypass surgery were retrieved during abdominal aneurysm repair. 27 One case report showed a large right-sided paracardiac mass caused by a right atrial temporary pacemaker wire. In two other case reports, a bronchocutaneous fistula, lobar consolidation, and bronchiectasis were the manifestations of retained temporary pacemaker wires.…”

Wandering Atrial Pacemaker Wire

“…The migration of retained temporary epicardial pacing wires is very rare but has been suspected to be due to direct perforation of the cardiac musculature or neighboring vascular structures. Most reported cases occurred within the context of an infection—a possible source of tissue weakening and disruption leading to direct perforation ( 2 ).…”

“…Among previously reported cases, the few wires that had migrated into the left heart were all found within the aorta or carotid arteries—none had been found within the LV. Only 1 other case ( 2 ) describes left-sided migration under noninfectious conditions. Previous cases hypothesized that the wires may have perforated through the aortic wall ( 3 ).…”