Case report discusses management strategies to prevent recurrence of idiopathic lead migration.
Reverse ratchet syndrome is an extremely rare form of idiopathic lead migration. Firm fixation of the lead sleeve to the fascia is crucial to prevent recurrence; however, even with reinforced fixation, muscle motion or intrinsic sleeve design may limit the ability to prevent idiopathic lead migration.
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Sakamoto et al. (2026) studied this question.
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