The journey of retained epicardial pacing wires: a systematic review of migration site and mechanisms

Abstract Background Temporary epicardial pacing wires are routinely placed during cardiac surgery and are typically removed before discharge. When resistance is encountered, wires are clipped and left in place. Although long considered benign, retained wires have increasingly been linked to delayed migration into vascular, thoracic, and abdominal structures. The patterns, timing, clinical consequences, and mechanisms of these events remain poorly defined. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta Analyses 2020 guidelines and was registered with the International Prospective Register of Systematic Reviews CRD420251103727. Main body Twenty-two studies describing 23 patients with migration of retained temporary epicardial pacing wires were included. Ages ranged from 14 months to 89 years. Migration occurred between 12 days and 17 years after surgery, with a median interval of approximately 1 year. Cardiovascular migration was reported in 15 patients and involved the aorta, aortic arch, carotid artery, coronary artery, pulmonary artery, or cardiac chambers. Extracardiac migration was reported in 8 patients and involved the lung, bronchial tree, transverse colon, neck, jaw, and subcutaneous tissues. Migration location corresponded to the reported origin of the pacing wire. Atrial wires were described in cases involving systemic arterial structures, whereas ventricular wires were described in cases involving the right heart or pulmonary circulation. Fourteen patients were symptomatic at diagnosis, presenting with chest pain, respiratory symptoms, hemoptysis, abdominal pain, neurologic deficits, or localized inflammation. Infectious complications were reported in 8 patients, including several cases in which more than 1 wire had been retained. Computed tomography identified migration in 13 patients and was the most frequently reported diagnostic modality. Echocardiography detected intracardiac migration in 6 patients. Percutaneous extraction was reported as successful in all attempted cases. Surgical extraction was performed in 3 patients, and 2 patients were managed conservatively. Conclusion Migration of retained temporary epicardial pacing wires has been reported months to years after cardiac surgery and has involved both cardiovascular and extracardiac structures. Reported cases describe migration across multiple anatomic pathways and a range of clinical presentations. Computed tomography was commonly used to identify migration, and percutaneous retrieval was reported as successful in several cases. These findings describe the reported spectrum of migration patterns, presentations, and management strategies among published cases of retained temporary epicardial pacing wire migration.