Delayed intracardiac migration of a retained epicardial pacing wire 14 years after coronary artery bypass grafting presenting with high-burden polymorphic ventricular ectopy: a case report

Temporary epicardial pacing wires (TEPWs) are routinely inserted during open-heart surgery and are usually removed before discharge. When retained, most remain clinically silent; however, late complications, including migration, erosion, infection, and arrhythmia, have been reported.

An 84-year-old man, 14 years after coronary artery bypass grafting, had an incidental metallic density on computed tomography. Imaging showed a retained wire perforating the right ventricular free wall and looping within the main and right pulmonary arteries. There were high burden ventricular ectopy and mild left ventricular systolic dysfunction.

The multidisciplinary team favoured surveillance rather than extraction, given chronicity, co-morbidities, and risk of surgery, with safety netting and scheduled rhythm follow-up to avoid delaying cancer surgery. This case highlights the value of imaging, multidisciplinary discussion, and patient-specific risk in assessing retained TEPWs. In late wire migration with trans-myocardial passage, active surveillance strategy may be appropriate when extraction risk is high and competing priorities exist.