Case report: Migrating temporary epicardial pacing wire eroding into an ascending aortic aneurysm

Introduction: Temporary epicardial pacing wires (TEPW) are commonly placed during cardiac surgery, and a known complication is the migration into visceral and vascular structures. Previous reports have identified TEPW migrating into the ascending aorta. These cases were managed conservatively with the initiation of antithrombotic medications and surveillance. We report the first case of TEPW migration associated with an ascending aortic aneurysm and the operative management.

Case presentation: A 73-year-old man with a history of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) in 2009 presented to the outpatient clinic for re-operative consideration due to severe bioprosthetic aortic stenosis, ascending aortic aneurysm, and multi-vessel coronary artery disease with occlusion of previous graft. He was incidentally found to have a TEPW eroding into his ascending aorta on pre-operative imaging. He was taken to the operating room for an AVR, ascending aorta replacement, and CABG. The TEPW was removed during the re-operation and the patient recovered well.

Clinical discussion: This is the first reported case of TEPW migration into an aneurysmal ascending aorta and the operative management. The patient tolerated the procedure well and was discharged home. Pre- and intra-operative images were obtained of TEPW extending into the lumen of the ascending aorta. If the patient did not have additional operative indications, conservative management could have been considered with antithrombotic medications and surveillance.

Conclusion: TEPW migration is a rare complication and requires special considerations with balancing risk for intervention.