Pacemaker lead migration
Citation, DOI & case data
Placement of a new dual chamber cardiac pacemaker two weeks ago and new onset of focal muscle twitching.
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dual chamber cardiac pacemaker with left subclavian access in situ
dislodgement and retraction of the non-fragmented right ventricular pacemaker lead which appears coiled around the implantable pulse generator with an additional loop directly with the tip in projection of the mid-clavicular line in the left subclavian/axillary vein
the right atrial pacemaker lead appears in place
enlarged cardiac silhouette and prominent pulmonary vasculature indicating congestion
The five common complications of pacemaker and cardiac resynchronization devices include hematoma, lead dislodgement, infection, lead perforation and dysrhythmias 1,2.
This is an example of lead dislodgement and extracardiac retraction of the right ventricular lead. Lead dislodgement most commonly occurs within the first three months of implantation and most commonly occurs in patients over 75 years of age 2. In this instance, there is a redundant lead wrapped around the pacemaker pulse generator device due to ongoing manipulation of the pulse generator in its subcutaneous pocket – this might be due to either reel syndrome or the ratchet mechanism or a combination of the two which is difficult to determine in this case by chest x-ray alone 3-5.
- 1. Aguilera A, Volokhina Y, Fisher K. Radiography of Cardiac Conduction Devices: A Comprehensive Review. Radiographics. 2011;31(6):1669-82. doi:10.1148/rg.316115529 - Pubmed
- 2. Townsend T. Five Common Permanent Cardiac Pacemaker Complications. Nursing Critical Care. 2018;13(4):46-8. doi:10.1097/01.ccn.0000534926.85924.91
- 3. Bellinge J, Petrov G, Taggu W. Reel Syndrome, a Diagnostic Conundrum: A Case Report. Eur Heart J Case Rep. 2021;5(10):ytab394. doi:10.1093/ehjcr/ytab394 - Pubmed
- 4. Kuş G, Cağırcı G, Üreyen Ç, Bayar N, Arslan Ş. Unexpected Cause of Involuntary Muscle Movements: Reel Syndrome. Anatol J Cardiol. 2021;25(7):515-6. doi:10.5152/AnatolJCardiol.2021.38445 - Pubmed
- 5. Golzio P, Bissolino A, Ceci R, Frea S. Ratchet Mechanism Selectively Causing Idiopathic Macrodislodgement of an Active-Fixation Coronary Sinus Lead: A Case Report. Eur Heart J Case Rep. 2020;4(6):1-6. doi:10.1093/ehjcr/ytaa466 - Pubmed