Reel syndrome: a rare cause of pacemaker malfunction

An 82-year-old woman was admitted to our hospital because of syncope. A 12-lead ECG demonstrated atrial fibrillation with a ventricular response of 35 bpm, and a VVIR (ventricular pacing, ventricular sensing, inhibiting mode, rate response function) pacemaker was implanted using a ventricular active fixation lead via the left subclavian artery. Prior to discharge a chest X-ray was taken and showed normal ventricular lead placement but with a minor lead retraction (figure 1A). One month after implantation she came again to the emergency room with dizziness with a ventricular response of 42 bpm. A chest X-ray was urgently performed and showed ventricular lead retraction (figure 1B, black arrow) secondary to rotation of the pulse generator …