Reverse Reel syndrome – An unusual case of myocardial perforation and liquidopneumothorax caused by migrated ventricular pacemaker lead

Ivica Paulić; Matija Marković; Ivica Premužić Meštrović; Tinamarel Mandić Paulić; Maja Vučković; Bojana Aćamović Stipinović; Mario  Stipinović

doi:10.23750/abm.v96i5.17032

Reverse Reel syndrome – An unusual case of myocardial perforation and liquidopneumothorax caused by migrated ventricular pacemaker lead

Authors

Ivica Paulić University Hospital Merkur, Department of cardiology, Faculty of medicine, University Zagreb, Zagreb, Croatia
Matija Marković University Hospital Merkur, Department of cardiology, Faculty of medicine, University Zagreb, Zagreb, Croatia https://orcid.org/0000-0002-2852-3730
Ivica Premužić Meštrović University Hospital Merkur, Department of cardiology, Faculty of medicine, University Zagreb, Zagreb, Croatia https://orcid.org/0000-0002-2592-8302
Tinamarel Mandić Paulić University Hospital Center Zagreb, Department of diagnostic and interventional radiology, Faculty of medicine, University Zagreb, Zagreb, Croatia https://orcid.org/0009-0003-8703-814X
Maja Vučković University Hospital Merkur, Department of cardiology, Faculty of medicine, University Zagreb, Zagreb, Croatia
Bojana Aćamović Stipinović University Hospital Merkur, Department of hematology, Faculty of medicine, University Zagreb, Zagreb, Croatia https://orcid.org/0000-0003-4542-0028
Mario Stipinović University Hospital Merkur, Department of cardiology, Faculty of medicine, University Zagreb, Zagreb, Croatia https://orcid.org/0000-0002-1582-1552

Keywords:

Reverse Reel syndrome, Pacemaker lead displacement, Myocardial perforation, Cardiac implantable electronic devices, Idiopathic lead migration, Twiddler´ s syndrome

Abstract

Reverse Reel Syndrome represents a rare but potentially life-threatening complication in patients with cardiac implantable electronic devices (CIEDs). This condition, characterized by the abnormal displacement and distal migration of pacemaker leads, can lead to severe adverse events due to tissue and organ damage caused by the sharp tip of an active lead.

Our case report highlights a unique instance of Reverse Reel Syndrome in an elderly female patient with early ventricular pacemaker lead distal migration resulting in life-threatening right ventricular myocardial perforation and left-sided liquidopneumothorax. Discussing the patient's characteristics, clinical presentation, and therapeutic considerations as essential factors in managing this complication, we emphasized the importance of preventive measures during implantation to mitigate risks associated with CIED complications.

References

1. Tseng AS, Shipman JN, Lee JZ et al. Incidence, patterns, and outcomes after transvenous cardiac device lead macrodislodgment: Insights from a population-based study. HeartRhythm. 2019 Jan;16(1):140-147. doi: 10.1016/j.hrthm.2018.07.026.

2. Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J. 1968 Aug 24-31;99(8):371-3. PMID: 4952398.

3. Vlay SC. Reverse Twiddler's syndrome. Pacing Clin Electrophysiol. 2009 Jan;32(1):146. doi: 10.1111/j.1540-8159.2009.02191.x.

4. Carnero-Varo A, Pérez-Paredes M, Ruiz-Ros JA et al. Reel Syndrome: a new form of Twiddler's syndrome? Circulation. 1999 Aug 24;100(8):e45-6. doi:10.1161/01.cir.100.8.e45.

5. Von Bergen NH, Atkins DL, Gingerich JC, Law IH. Ratchet syndrome, another etiology for pacemaker lead dislodgement: a case report. HeartRhythm. 2007 Jun;4(6):788-9. doi:10.1016/j.hrthm.2006.12.029.

6. Machraa A, Sidaty O, Fellat N, Fellat R. An unusual cause of pacemaker malfunction: A case report of an association of twiddler and reel syndrome. Ann Med Surg (Lond). 2022 Nov 11;84:104857. doi: 10.1016/j.amsu.2022.104857.

7. Morales JL, Nava S, Márquez MF et al. Idiopathic Lead Migration: Concept and Variants of an Uncommon Cause of Cardiac Implantable Electronic Device Dysfunction. JACC Clin Electrophysiol. 2017 Nov;3(11):1321-1329. doi: 10.1016/j.jacep.2017.02.015.

8. Vlay SC. Complications of active-fixation electrodes. Pacing Clin Electrophysiol. 2002 Aug;25(8):1153-4. doi: 10.1046/j.1460-9592.2002.01153.x.

9. Simsolo E, Wilkoff BL. A Shocking Case of Pacemaker Lead Perforation. JACC Case Rep. 2022 Sep 21;4(18):1203-1205. doi: 10.1016/j.jaccas.2022.07.003.

10. Salahuddin M, Cader FA, Nasrin S, Chowdhury MZ. The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure. BMC Res Notes. 2016 Jan 20;9:32. doi:10.1186/s13104-015-1818-0.

11. Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. PacingClinElectrophysiol. 2007 Jan;30(1):28-32. doi: 10.1111/j.1540-8159.2007.00575.x.

12. Alla VM, Reddy YM, Abide W, Hee T, Hunter C. Delayed lead perforation: can we ever let the guard down? Cardiol Res Pract. 2010 Jul 25;2010:741751. doi: 10.4061/2010/741751.

13. Forsell C, Gasser TC . Numerical simulation of the failure of ventricular tissue due to deep penetration: the impact of constitutive properties. Journal of biomechanics 44, no. 1 (2011): 45-51.doi.org/10.1016/j.jbiomech.2010.08.022.

14. Archontakis, S, Sideris, K, Aggeli, K, et al. Percutaneous lead extraction and repositioning: An effective and safe therapeutic strategy for early ventricular lead perforation with dislocation both inside and outside the pericardial sac following a cardiac device implantation. J cardiovasc Electrophysiol. 2019; 30: 299 307. https://doi.org/10.1111/jce.13804