REEL syndrome

A 58-year-old male tourist with a recently implanted cardiac resynchronization therapy defibrillator (CRT-D) device came to our emergency department because of pectoralis muscle stimulation. Thoracic X-ray revealed a dislodgement of the left ventricular lead back to the pocket (a, large arrow). This phenomenon is called REEL syndrome and involves rotation of the pacemaker on its transverse axis, with subsequent lead retraction. In contrast to the Twiddler syndrome, which occurs due to the rotation of the pacemaker on its long axis, the REEL syndrome is usually not caused by patient manipulation but may be due to inaccurate sleeve fixation and placement of the leads around, instead of behind, the generator (b, small doted arrows). LV lead stimulation was turned off, and the patient was advised for repositioning of the lead in his home hospital. …