Reel’s syndrome, an unusual cause of lead displacement

Background: Ventricular capture failure could be a sign of macrodisplacement. Electrode displacement is one of the complications related to cardiac pacing. Knowing the different production mechanisms of macrodisplacements is not just for a nominal distinction. It is important to understand that the mechanisms are different, that´s why each type of macrodisplacement requires different form of therapy. Case report: A 79-year-old male patient. On physical examination, the heart rate was 38 beats per minute. The 12-lead electrocardiogram (ECG-12) showed a second-degree 2:1 atrioventricular block. It was decided to implant a VVIR pacemaker. On follow-up, the ECG-12 review showed ventricular capture failure without spike and 2:1 atrioventricular block. The fluoroscopic study showed electrode displacement. The distal tip of the electrode was in the area of the pacemaker pocket with radiological appearance of thread wound on a reel. Reintervention was immediately decided, during surgery, the diagnosis of reel type macrodisplacement was corroborated. The lead was repositioned in the right ventricle. Conclusions: Knowledge of the risk factors allows us to avoid macrodisplacement syndromes of the electrode. Knowing the different mechanisms of production of the three syndromes described is of great importance to finally carry out the appropriate therapy.