Key result
Conservative therapy with antiplatelets maintains 1-year stability in asymptomatic migrated epicardial pacing wire.
Why the study?
Retained temporary epicardial pacing wires can migrate after CABG, but migration into the left heart is exceedingly rare.
Case Report (n=1)
No
Left-sided migration of a retained temporary epicardial pacing wire can remain asymptomatic for decades and may be safely managed with conservative therapy (antithrombotics and surveillance) in selected patients where retrieval poses excessive risk.
May support conservative antithrombotic surveillance in select high-risk asymptomatic cases; leaves open need for prospective validation.
BACKGROUND: Retained temporary epicardial pacing wires (TEPWs) can migrate after coronary artery bypass grafting; left heart migration is exceedingly rare. CASE SUMMARY: An 81-year-old man presented 24 years after coronary artery bypass grafting. Routine echocardiography revealed a linear echogenic metallic structure traversing the right atrium, atrial septum, left atrium, and mitral valve into the left ventricle, confirmed by transesophageal echocardiography and computed tomography. He was asymptomatic with no infection or thromboembolism, and retrieval was deemed too high risk; thus, he was managed conservatively with anticoagulation (switched to dual antiplatelet therapy given intolerance) and surveillance every 6 months, remaining clinically stable at 1 year. DISCUSSION: Left-sided TEPW migration poses unique thromboembolic risks. Unlike prior cases, ours lacked infection, followed a novel transatrial trajectory, and represented the longest reported asymptomatic interval (24 years), underscoring conservative management in carefully selected patients. TAKE-HOME MESSAGES: Left-sided TEPW migration can remain asymptomatic for decades. Conservative management with anticoagulation and serial surveillance is viable in the absence of infection, hemodynamic compromise, or further migration.
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Shah et al. (2026) conducted a case report in Migrated retained temporary epicardial pacing wire (TEPW) to the left heart (n=1). Conservative management (dual antiplatelet therapy and serial surveillance) was evaluated on Clinical stability and absence of complications (thromboembolism, endocarditis). Conservative management with antiplatelet therapy and serial surveillance is a viable strategy for asymptomatic left-sided migration of a retained temporary epicardial pacing wire, with the patient remaining clinically stable at 1 year.
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