Reel Syndrome and Pulsatile Liver in a Patient With a Two-chamber Pacemaker

Abstract

SUMMARYTwiddler's syndrome is characterized by coiling of the pacemaker lead due to the rotation of the pacemaker generator on its long axis. Reel syndrome is another form of Twiddler's syndrome. It occurs due to the rotation of the pacemaker generator on its transverse axis with subsequent coiling of the pacemaker leads around the pulse generator. In this article we describe a patient with a two-chamber pacemaker who presented with sudden onset of abdominal pulsation and was subsequently diagnosed as Reel syndrome. To the best of our knowledge, this case is the first case of Reel syndrome that developed in a patient with a two-chamber pacemaker. (Jpn Heart J 2004; 45: 1037-1042

Reel syndrome: dislodgement of an active fixation lead

“…However, this syndrome was thought to be a variant of Twiddler's syndrome, consciously or unconsciously manipulation by the patient is not required (1)(2)(3)(4)(5). We thought that Reel syndrome is better defines the clinical scenario occurred in our case.…”

Complications of Pacemaker Implantation

“…Typically, placement beneath the pectoral muscle and suturing the generator to the underlying fascia is thought to preclude the patient from manipulating the device. Additionally, "Reel syndrome" (Carnero-Varo et al, 1999;Vural et al, 2004) has been described, which entails the generator rotating around its transverse axis "reeling" in the lead. In certain adult populations, such as in patients with a history of significant weight loss, the "Sagging Heart syndrome" may represent a previously unrecognized cause of acute lead dislodgment (Iskos et al, 1999).…”

Reel Syndrome: A Variant Form of Twiddler’s Syndrome

“…Other preventive measures include using a compression band around the upper chest and shoulder, and tightening of the patient's arm for at least five to seven days. 11) The use of a Dacron patch would stabilize the pulse generator by promoting tissue in-growth. The necessity for careful follow-up, especially in the first few months after surgery, needs to be underscored.…”

“…3,[8][9][10] Most of the reported cases of reel syndrome describe lead dislodgement without damage to the lead. 3,7,9,11,12) On the other hand, twiddler's syndrome is frequently associated with lead dislodgement, either with lead fracture or insulation leakage. 13,14) In this report, we describe a patient with a dual chamber pacemaker who presented with sudden onset of syncope after 2 weeks of implantation and was subsequently diagnosed as having reel syndrome.…”