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Europace Advance Access originally published online on July 16, 2007
Europace 2007 9(8):674; doi:10.1093/europace/eum141
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

PACING AND LEAD EXTRACTION

Reel syndrome in a patient with a three-chamber implantable cardiovertor-defibrillator

Ilyas Atar, Tayfun Acil* and Bülent Özin

Department of Cardiology, Faculty of Medicine, Baskent University, Ankara, Turkey

Manuscript submitted 11 March 2007. Accepted after revision 19 June 2007.

* Corresponding author:, Baskent Üniversitesi-Adana Arastirma ve Uygulama Merkezi, Kardiyoloji Bölümü, Dadaloglu mahallesi, Serin evler, 39 Sokak No. 6, 01250 Yüregir, Adana, Turkey. Tel: +90 322 3272727; fax: +90 322 3271273. E-mail address: tayfun.acil{at}gmail.com

Key Words: Dilated cardiomyopathy, Implantable cardiovertor-defibrillator, Pacemaker

A 54-year-old woman with non-ischaemic dilated cardiomyopathy and syncopal episodes due to ventricular tachycardia had undergone implantation of a three-chamber implantable cardiovertor-defibrillator (CRT-D, Contak Renewal 4 Guidant, St Paul, MN, USA). A passive fixation bipolar lead was placed in the appendix of the right atrium (Guidant Fineline Sterox II 4480), a passive fixation bipolar, dual-coil lead (Guidant Reliance 0148) was placed in the apex of the right ventricle, and a bipolar left-ventricular (LV) pacemaker lead (Guidant Easytrak 3 4527) was placed in a lateral tributary of the coronary sinus. Forty days after the implantation, the patient presented with occasional muscle twitching on the left side of her chest. Her symptoms were reproduced immediately after the output voltage of the LV lead was increased. Fluoroscopic examination revealed that the LV lead was coiled around the pulse generator and retracted (Figure 1). The right ventricular lead was minimally retracted, whereas the atrial lead was intact. Revision of the CRT-D was also performed.


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  		Figure 1 Fluoroscopic image demonstrating coiling of pacemaker leads around the pulse generator. There is a retraction of the left ventricular lead (arrow).

 
Twiddler's syndrome is characterized by the coiling of the pacemaker lead due to the rotation of the pacemaker generator on its long axis.1Go The Reel syndrome, a recently described form of Twiddler's syndrome, occurs due to the rotation of the pacemaker generator on its transverse axis with subsequent coiling of the pacemaker leads around the pulse generator.

Conflict of interest

none declared.


   References
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[1] Schulten HK, du Mesnil de Rochemont W, Jochem W, Baldus O, Grosser KD, Behrenbeck DW. Interference of pacemaker stimulation due to battery rotation (pacemaker-Twiddler syndrome). Med Welt (1975) 26:1406–7.[Medline]


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[Abstract] [Full Text] [PDF]

This Article
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