Isolated left ventricular lead dislodgement: an unusual case of pacemaker’s Reel/Twiddler’s syndrome

Abstract

Introduction: Reel syndrome resulting in lead dislodgement is a rare, but well-known complication of cardiac device implantation. Therefore, it has to be considered in case of device dysfunction. Case description: We present the case of a 64-year-old male patient who visited our ward following an ICD shock. He had heart failure with reduced ejection fraction, and had a CRT-D device implanted 2 years before. The 12-lead ECG showed a septal pacemaker rhythm. Device interrogation verified adequate ICD therapy, with left ventricular sensing and capture failure. Chest X-ray showed optimal right atrial and defibrillator lead position. The left ventricular lead was not present near the heart. Our patient reported that he regularly manipulated the area around the device. During the pacemaker system revision, the diagnosis of isolated coronary sinus lead Reel syndrome was verified. We removed the old lead and implanted a new one in a good position in a lateral vein. Discussion: Thorough patient education and regular check-ups for patients living with permanent pacemakers and implantable cardioverter defibrillators are essential. Migration of the device can occur in some rare cases, leading to lead dislodgement. We can reduce the risk of these complications by appropriately anchoring leads and generators.

Keywords

• crt-d
• lead dysfunction
• dislodgement
• reel syndrome
• twiddler’s syndrome