Key result
Migrating epicardial pacing wire triggers high-burden polymorphic ventricular ectopy 14 years post-CABG.
Why the study?
Temporary epicardial pacing wires can rarely cause late complications such as migration, erosion, infection, and arrhythmia when retained after cardiac surgery.
Case Report (n=1)
Active surveillance may be an appropriate management strategy for late trans-myocardial migration of retained epicardial pacing wires when extraction risk is high and competing clinical priorities exist.
Surveillance may be reasonable for late-migrated epicardial wires in high-risk patients; leaves optimal management strategy unresolved.
Background Temporary epicardial pacing wires (TEPWs) are routinely inserted during open-heart surgery and are usually removed before discharge. When retained, most remain clinically silent; however, late complications including migration, erosion, infection, and arrhythmia have been reported. Case An 84-year-old man, 14 years after CABG, had an incidental metallic density on CT. Imaging showed a retained wire perforating the right ventricular free wall and looping within the main and right pulmonary arteries. There were high burden ventricular ectopy and mild LVSD. Management The multidisciplinary team favoured surveillance rather than extraction, given chronicity, co-morbidities and risk of surgery, with safety netting and scheduled rhythm follow up to avoid delaying cancer surgery. Conclusion This case highlights the value of imaging, multidisciplinary discussion, and patient-specific risk in assessing retained TEPWs. In late wire migration with trans-myocardial passage, active surveillance strategy may be appropriate when extraction risk is high and competing priorities exist.
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Badr et al. (2026) conducted a case report in Retained epicardial pacing wire with high-burden polymorphic ventricular ectopy (n=1). Active surveillance was evaluated. Active surveillance was favored over extraction for an 84-year-old man with a retained epicardial pacing wire perforating the right ventricle 14 years after CABG, given high surgical risk.