Migration of a Retained Epicardial Pacing Wire Into the External Carotid Artery

Temporary epicardial pacing wires (TEPWs) are commonly used for postoperative arrhythmia management in cardiac surgery. Although generally safe, they can cause rare complications, including migration years after placement.

A 59-year-old man with a history of cardiac arrest and acute myocardial infarction requiring urgent coronary artery bypass grafting 2 years prior presented with new-onset dysphagia and odynophagia. Full workup and imaging revealed a migrated TEPW embedded in the right external carotid artery. The wire was successfully removed using advanced endovascular techniques, providing immediate symptom relief.

This rare case of a retained TEPW highlights the importance of "thinking outside the box." Combinatorial analysis, which combines medical knowledge with comprehensive data from numerous simple observations, tests, and procedures, guided us to the optimal treatment for our patient.

Clinicians should maintain vigilance for delayed TEPW complications and consider alternatives that reduce long-term risks associated with retained wires.