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Silent Migration of Retained Epicardial Pacing Wire to the Left Heart 24 Years After CABG
Haider Hussain Shah1, Muhammad Adnan Zaman2, Mohammad Omar Butt3
1Department of Medicine, Bayhealth Hospital, Dover, Delaware, USA.
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.
