Key result
Progressive slack in a right ventricular pacemaker lead caused by arm movements and anticlockwise rotation of the generator led to its displacement into the pulmonary artery, termed 'reverse ratchet' syndrome.
Why the study?
Lead displacement is a common complication of pacemaker implantation, and this report describes an unusual presentation of late, asymptomatic lead displacement caused by reverse ratchet syndrome.
Case Report (n=1)
This case highlights 'reverse ratchet' syndrome as a rare mechanism of late, asymptomatic pacemaker lead displacement into the pulmonary artery, emphasizing the importance of proper pocket sizing and lead fixation.
Alerts clinicians to rare mechanical lead displacement; hypothesis-generating and leaves open optimal fixation strategies.
Lead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage. During a routine pacemaker follow up, it was noted that the right ventricular (RV) threshold had increased and deteriorated over time. The pacemaker box had rotated anticlockwise and the RV lead had developed a loop that eventually led to its retraction from the RV implantation position into the pulmonary artery. The patient was asymptomatic; however, he underwent RV lead revision. Patient education, opening an appropriate pocket for the size of the generator, fixing the sleeves to an appropriate tightness and securing the battery with a strong suture all can be used to avoid lead displacement.
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Enab et al. (2021) conducted a case report in Sinus node dysfunction with pacemaker lead displacement (n=1). Dual-chamber pacemaker implantation was evaluated on Pacemaker lead displacement. Progressive slack in a right ventricular pacemaker lead caused by arm movements and anticlockwise rotation of the generator led to its displacement into the pulmonary artery, termed 'reverse ratchet' syndrome.
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