title: Is this the natural history of the retention wire? A case report.
abstract: We report on a 71-year-old man who had a dual chamber pacemaker implanted in 1991. A Class IV fracture of the Telectronics Accufix 330-801 atrial lead was observed on a chest X ray in December 1993. Serial chest X ray and fluoroscopy documented stable position of the migrated fractured J wire. The patient remained asymptomatic and a decision for conservative monitoring was made. A subsequent finding of a right atrial mass on echocardiography and evidence of pulmonary embolism on lung scan prompted a change of strategy. The patient underwent atriotomy, and a right atrial thrombus was discovered associated with the fractured J retention wire, both of which were extracted uneventfully. This case is illustrative that despite apparent stability of a Class IV fracture, it may result in endothelial injury with a thrombogenic nidus and resultant complications.
authors.affiliation: Division of Cardiology, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Lau
authors.forename: S C
authors.initials: SC
authors.lastname: Nishimura
authors.forename: D
authors.initials: D
authors.lastname: Oxorn
authors.forename: B S
authors.initials: BS
authors.lastname: Goldman
mesh_terms: D000368:Aged; D004868:Equipment Failure; D006325:Heart Atria; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors