Discussion
A fracture and retention of guide-wires are uncommon but a known complication of the interventional cardiology procedures. Most cases are diagnosed immediately or just after the procedures and the wires are retrieved either percutaneously or surgically [3]. Rarely, the fractured wire may be missed inadvertently at the time of procedure and diagnosed late when the patient had complications related to the retained foreign body [4], or incidentally diagnosed while diagnostic evaluation for the other diseases.
Our patient had undergone two procedures; first, for implantation of cardiac resynchronization therapy defibrillator (CRT-D) 3 years back, and second, for replacement of left ventricular and right atrial lead for lead dysfunction 6 months ago. Both the procedures were done at different centres. Our patient had presented with pain in left arm and shoulder due to migration of guide-wire from CRT-D pocket to left upper arm, which became severe when the tip of the wire reaches to subcutaneous tissue after crossing the deltoid muscle of the left arm. Probably, the wire was fractured at the time of previous procedure and was inadvertently missed at that time and retained in the pectoral muscles and gradually migrated over time to arm with the movement of the arm. Management of retained guide-wire is the retrieval of the wire using either a percutaneous technique or open surgical technique [5]. In our patient as the wire was impacted in arm muscles, and was not suitable for percutaneous retrieval and thus open surgical retrieval was done.