IS THIS THE NATURAL-HISTORY OF THE RETENTION WIRE - A CASE-REPORT

We report on a 72-year-old man who had a dual chamber pacemaker implan ted in 1991. A Class IV fracture of the Telectronics Accufix 330-801 a trial lead was observed on a chest X ray in December 1993. Serial ches t X ray and fluoroscopy documented stable position of the migrated fra ctured J wire. The patient remained asymptomatic and a decision for co nservative monitoring was made. A subsequent finding of a right atrial mass an echocardiography and evidence of pulmonary embolism on lung s can prompted a change of strategy. The patient underwent atriotomy, an d a right atrial thrombus was discovered associated with the fractured J retention wire, both of which were extracted uneventfully. This cas e is illustrative that despite apparent stability of a Class IV fractu re, it may result in endothelial injury with a thrombogenic nidus and resultant complications.