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

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.