Ventricular tachycardia associated with transmyocardial migration of an epicardial pacing wire

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
• Temporary epicardial pacing wires are often used during CABG for hemodynamic support.
• Complications from retained pacing wires are rare but can be serious.

Observation:

• A 66-year-old male presented with ventricular tachycardia and cardiac arrest 3 years post-CABG.
• Echocardiography revealed a wire in the right ventricle extending into the pulmonary artery.
• The wire was identified as a retained epicardial pacing wire from the prior surgery.

Findings:

• The retained pacing wire is suspected to have eroded through the right atrium into the right ventricle.
• This migration likely contributed to the patient's ventricular tachycardia and cardiac arrest.
• The case underscores the potential for late complications from retained epicardial pacing wires.

Implications:

• Highlights the importance of ensuring complete removal of temporary epicardial pacing wires after cardiac surgery.
• Suggests a need for vigilance in diagnosing late-onset arrhythmias potentially related to retained foreign bodies.
• Emphasizes the critical role of echocardiography in identifying intracardiac foreign bodies and guiding management.