Introduction: The Reel syndrome is an uncommon recently described cause of pace-maker dysfunction characterized by rotation of generator on its transverse axis with rolling of the electrode around it.
Case Report: An 80 years old woman who suffered with alcoholic liver disease was referred to our hospital for congestive heart failure and bradycardia. She underwent two weeks before a single chamber pacemaker (VVI-mode) implantation for symptomatic atrial fibrillation with a slow ventricular rate. Surface ECG showed an inconstant capture defects and a promptly device evaluation confirmed an high-threshold stimulation on ventricular leads. Chest radiograph showed an unexpected and surprising picture: the ventricular lead was dislodged and the pulse generator was rotated 180 degrees along its longitudinal axis (Fig.1). The following day a re-implantation of catheters was performed.
Conclusions: The Reel syndrome should be considered in patients with device dysfunction. It frequently reported in patients with mental disorders, in obese patients with very lax subcutaneous tissues, in children and in very old people or in presence of large pacemaker pocket. In these cases the fixation of the pulse generator can be considered.