The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review

Patris, Vasileios; Argiriou, Mihalis; Salem, Agni-Leila; Giakoumidakis, Konstantinos; Baikoussis, Nikolaos G; Charitos, Christos

doi:10.4103/0971-9784.191567

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…The residual wire is expected to retract into the tissue before discharging the patient [ 9 ]. Retained pacing wires cause no symptoms in most cases; however, they have been related to some complications reported in the literature including hemopericardium [ 10 ], bronchocutaneous fistula [ 11 ], retroaortic abscess [ 12 ], prosthetic valve endocarditis [ 13 ], and migration to the intraperitoneal cavity [ 14 ] and breast [ 8 ]. Our patient underwent tricuspid valve repair 2 years prior to presentation.…”

Section: Discussionmentioning

confidence: 99%

An unusual cause of a breast mass in a 13-year-old girl: a case report

et al. 2018

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BackgroundAdolescents rarely present with breast lumps, and such lumps are usually due to benign causes. Foreign bodies in the breast are an uncommon finding and could be detected incidentally during imaging or be symptomatic and present as a painful mass. Sometimes they cause diagnostic dilemmas as they mimic malignancies. To the best of our knowledge, this is the second case reported in the literature about an abscess caused by a migrating retained temporary epicardial pacing wire.Case presentationA 13-year-old girl of African ancestry was referred to our clinic with a left breast mass that had been gradually increasing in size for 2 years. The mass was tender but was not associated with skin changes, nipple discharge, or fever. She had a history of rheumatic heart disease and had undergone mitral and tricuspid valve repair more than 2 years ago. Blood work and biochemistry were within normal ranges. An ultrasound of her left breast showed a large, irregular, complex, heterogeneous mass measuring 4.3 × 2.7 × 3.5 cm at 6 o’clock position with central cystic changes but no significant intrinsic vascular flow. There was significant associated skin and subcutaneous edema. Given the echogenicity of the mass, an infectious cause was considered likely, and malignancy was less likely but could not be excluded. An ultrasound-guided biopsy was performed and revealed cores of breast tissue heavily infiltrated with mixed acute and chronic inflammatory cells, consistent with a chronic abscess. She received a 10-day course of antibiotics. However, she remained symptomatic, and the mass did not decrease in size. Therefore, we proceeded to surgical excision. The breast mass was excised. It was fixed to the underlying rib, and a thin, long, metallic wire that moved with her heartbeat was observed protruding from a small opening above the rib. This was a migrated retained epicardial pacing wire from the previous valve repair surgery. The histopathology of the mass revealed mammary tissue with acute and chronic inflammatory cells.ConclusionTemporary epicardial pacing wires should be removed completely by cardiothoracic surgeons after surgery to avoid migration that might lead to unexpected complications.

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Section: Discussionmentioning

confidence: 99%

An unusual cause of a breast mass in a 13-year-old girl: a case report

et al. 2018

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Retained Temporary Epicardial Pacing Wires

et al. 2020

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Introduction Temporary epicardial pacing wires (TEPW) are used in the immediate postoperative cardiac surgery period for the identification, diagnosis, and treatment of acute arrhythmias. They are usually removed before discharge, but are sometimes clipped and left to retract into the skin and are thus retained. Rare complications from these retained wires have been documented in numerous case reports. We describe a case of a 57-year-old man with chronically draining wounds due to infected retained pacing wires. This case prompted a systematic review of these patients to delineate complications and to create a novel treatment algorithm. Methods The authors conducted a systematic review of MEDLINE, Embase, and the Cochrane Library databases and retrieved relevant, English-language articles published between 1986 and 2018. Two reviewers critically appraised the studies that met inclusion and exclusion criteria. Results Thirty-one articles met inclusion criteria with a total of 35 patients included. The existing articles represent either level IV or level V evidence. Mean ± SD time of presentation from initial TEPW placement was 4.9 ± 5.9 years, with a range of 1 month to 24 years and 77% of patients were symptomatic. The TEPW wire migration occurred in 74% of patients, with invasion into vasculature, visceral organs, and subcutaneous tissue. Most of the patients who underwent wire removal had complete recovery. The relevant literature suggests that there is a wide range of complications, and migration is more often associated with need for surgical intervention. Conclusions In patients with severe symptoms or evidence of migration, surgical intervention and removal should be strongly considered to prevent potentially deadly complications. We propose an algorithm to minimize these complications based on a literature analysis in accordance with PRISMA guidelines.

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Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study

2020

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Background: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. Methods: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. Results: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. Conclusion: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.

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The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review

Cited by 4 publications

References 4 publications

An unusual cause of a breast mass in a 13-year-old girl: a case report

An unusual cause of a breast mass in a 13-year-old girl: a case report

Retained Temporary Epicardial Pacing Wires

Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study

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