An unusual case of cardiac resynchronization therapy non-responder: the reel syndrome

Abstract

A 62-year-old man with ischaemic cardiomyopathy complained of an increase of basal dyspnoea. A CRT-D (Medtronic InSync III Marquis, Minneapolis, MN, USA) was implanted 7 months ago. The leads were inserted without complication through the left subclavian vein and secured with a non-absorbable ligature to the fascia. The generator was not sutured to the pectoral fascia. The patient had been better since the device was implanted, but in the last 3 months had worsened. A radiograph of the chest demonstrated a displacement of the left ventricular lead (Medtronic Attain 4194, 88 cm, Minneapolis, MN, USA), with winding of the lead around the pacemaker box, which presented an horary rotation (Panel A: pos CRT-D implantation; Panel B: left lead dislocation). When he was interrogated he referred a spontaneous twist of the box 3 months ago. Spontaneous displacement of the pacemaker lead due to the rotation of the generator on its transverse axis is known as the ‘reel syndrome’. An insufficient fixation of the leads/generator may contribute to it. In this case, the rotation of the generator (not secured to the fascia) resulted in reeling in of the pacemaker lead. The box and a new lead were fixed securely and carefully without complications.