Wald Gal, Van Y-Vu Robert, Pain Kevin J, Otterburn David M
From the Weill Cornell Medicine.
New York Presbyterian Hospital, Weill Cornell and Columbia Plastic Surgery Residency Programr.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S44-S49. doi: 10.1097/SAP.0000000000002326.
Temporary epicardial pacing wires (TEPW) are used in the immediate postoperative cardiac surgery period for the identification, diagnosis, and treatment of acute arrhythmias. They are usually removed before discharge, but are sometimes clipped and left to retract into the skin and are thus retained. Rare complications from these retained wires have been documented in numerous case reports. We describe a case of a 57-year-old man with chronically draining wounds due to infected retained pacing wires. This case prompted a systematic review of these patients to delineate complications and to create a novel treatment algorithm.
The authors conducted a systematic review of MEDLINE, Embase, and the Cochrane Library databases and retrieved relevant, English-language articles published between 1986 and 2018. Two reviewers critically appraised the studies that met inclusion and exclusion criteria.
Thirty-one articles met inclusion criteria with a total of 35 patients included. The existing articles represent either level IV or level V evidence. Mean ± SD time of presentation from initial TEPW placement was 4.9 ± 5.9 years, with a range of 1 month to 24 years and 77% of patients were symptomatic. The TEPW wire migration occurred in 74% of patients, with invasion into vasculature, visceral organs, and subcutaneous tissue. Most of the patients who underwent wire removal had complete recovery. The relevant literature suggests that there is a wide range of complications, and migration is more often associated with need for surgical intervention.
In patients with severe symptoms or evidence of migration, surgical intervention and removal should be strongly considered to prevent potentially deadly complications. We propose an algorithm to minimize these complications based on a literature analysis in accordance with PRISMA guidelines.
临时心外膜起搏导线（TEPW）在心脏手术后即刻用于急性心律失常的识别、诊断和治疗。通常在出院前拔除，但有时会被剪断并任其回缩至皮下从而得以保留。众多病例报告记录了这些保留导线引发的罕见并发症。我们描述了一例57岁男性患者，因感染的保留起搏导线导致伤口长期引流。该病例促使我们对这些患者进行系统回顾，以明确并发症并创建一种新的治疗算法。
作者对MEDLINE、Embase和Cochrane图书馆数据库进行了系统回顾，并检索了1986年至2018年间发表的相关英文文章。两名审阅者对符合纳入和排除标准的研究进行了严格评估。
31篇文章符合纳入标准，共纳入35例患者。现有文章代表IV级或V级证据。从最初放置TEPW到出现症状的平均±标准差时间为4.9±5.9年，范围为1个月至24年，77%的患者有症状。74%的患者发生了TEPW导线移位，侵入血管、内脏器官和皮下组织。大多数接受导线拔除的患者完全康复。相关文献表明存在广泛的并发症，移位更常与手术干预的需要相关。
对于有严重症状或移位证据的患者，应强烈考虑手术干预和拔除，以预防潜在的致命并发症。我们根据PRISMA指南进行文献分析，提出一种算法以尽量减少这些并发症。
