Key result
Lead replacement resolves atypical ratchet syndrome presenting as right hemidiaphragmatic twitching after late atrial dislodgement.
Case Report (n=1)
Right hemidiaphragmatic twitching is an atypical but important clinical sign of right phrenic nerve pacing due to atrial lead dislodgement and ratchet syndrome.
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Szotek et al. (2026) conducted a case report in Ratchet syndrome associated with late atrial lead dislodgement (n=1). Atrial lead replacement was evaluated. Right hemidiaphragmatic twitching is an atypical manifestation of ratchet syndrome due to late atrial lead dislodgement, which was successfully resolved in a 72-year-old woman via lead replacement.
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