Safety of temporary pacemaker wires

Abstract

It is routine practice to insert temporary pacemaker wires in cardiac surgery patients. In selected patients, temporary pacemakers are helpful in the management of cardiac surgery patients intra- and postoperatively. Although this practice is generally safe, a small percentage of patients may have complications at the time of insertion, during pacing postoperatively, at the time of pacemaker wire removal, or if temporary wires are retained inside the body. This review will shed some light on the safety issues of temporary pacemaker wire usage.

An unusual case of stabbing chest pain …literally: a case report

“…Temporary epicardial pacing wire insertion is routine practice in cardiac surgery patients, although controversy exists in this matter, since only a small minority of patients require in fact pacing therapy to wean from cardiopulmonary bypass. 3 , 4 Temporary epicardial pacing wires are usually manufactured with a small needle on one end, used to embed the wire in the myocardium, after which the needle is cut-off. Some wires may be coiled/clipped to assist fixation into the myocardium or loosely sutured to the surface of the heart.…”

“…Bleeding, either from laceration of the cardiac chambers or laceration/avulsion of coronary grafts, cardiac tamponade, haemothorax, infection/migration of retained wires, and bronchocutaneous fistulas, although rare, have all been previously described. 3–6 …”

Temporary Epicardial Pacing Wire Migration into the Right Heart, 10 Months after Coronary Artery Bypass Surgery

“…We commonly remove the wire by gentle traction before discharge, and the overall incidence of TEPW-related complications is low. In a small number of patients (0.4%), however, TEPW removal can result in critical complications, such as coronary graft and myocardium injury, bleeding, and mortality Del Nido 1989;Carroll 1998;Elmistekawy 2019]. Therefore, in case of bleeding tendencies resulting from antiplatelet and warfarin medications, TEPWs are cut just at the skin level and retained [Carroll 1998;Shaikrezai 2012].…”

“…Therefore, in case of bleeding tendencies resulting from antiplatelet and warfarin medications, TEPWs are cut just at the skin level and retained [Carroll 1998;Shaikrezai 2012]. Retained TEPWs may cause early complications such as irritation, pain, and erosion, and there have been reports of delayed complications associated with retained TEPWs, such as abscess formation, infection, and distant migration [Shaikrezai 2012;Elmistekawy 2019].…”

“…The migration of retained TEPWs is an extremely rare but serious complication [Shaikrezai 2012;Elmistekawy 2019]. Retained wires can migrate to other structures with no clear mechanism.…”