Key result
Percutaneous extraction successfully retrieves retained epicardial pacing wires from the aortic arch and pulmonary artery.
Why the study?
Migration of retained temporary epicardial pacing wires after cardiac surgery and their percutaneous extraction is a clinical scenario requiring description.
Case Report (n=1)
This case demonstrates that retained temporary epicardial pacing wires can migrate into major cardiovascular structures over time and can be successfully retrieved via percutaneous extraction.
Answers are grounded in this paper and cite their sources.
Retained epicardial wires may migrate into major vessels; this single case leaves open optimal surveillance or extraction strategies.
A 61-year-old man was referred with acute type A aortic dissection and underwent emergent hemiarch graft replacement with open stent graft implantation into the distal aortic arch. Atrial and ventricular bipolar temporary epicardial pacing wires (TEPWs) were placed after surgery. On the seventh post-operative day, the TEPWs were cut at the level of the skin, but left in place after an unsuccessful attempt at removal with gentle traction. Post-operative computed tomography revealed retained TEPWs at the level of the skin (Panel A, red arrow; atrial TEPW, blue arrow; ventricular TEPW). Follow-up computed tomography performed 1 year after the operation revealed that the atrial TEPW had migrated into the aortic arch via the artificial graft and the ventricular TEPW had migrated into the right pulmonary artery via the right ventricle (Panels B–E). Percutaneous extraction was performed through the femoral artery and vein. The atrial TEPW was captured by a snare guiding catheter and gently pulled out (Panel F; Supplementary material online, Movie S1). The ventricular TEPW was captured by a pigtail catheter and gently pulled out (Panel G; Supplementary material online, Movie S2). On gross examination, the atrial TEPW was a 27-mm long segment and the ventricular TEPW was a 20-mm long segment (Panel H).
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Domoto et al. (2016) conducted a case report in Migration of retained epicardial pacing wires (n=1). Percutaneous extraction was evaluated on Successful extraction of migrated pacing wires. Retained temporary epicardial pacing wires migrated into the aortic arch and right pulmonary artery 1 year post-surgery and were successfully extracted percutaneously.
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