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(Circulation. 1999;100:e45-e46.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

"Reel Syndrome"

A New Form of Twiddler's Syndrome?

Andrés Carnero-Varo, MD; Matías Pérez-Paredes, MD; José Antonio Ruiz-Ros, MD; Diego Giménez-Cervantes, MD; Francisco R. Martínez-Corbalán, MD; Tomás Cubero-López, MD; Pedro Jara-Pérez, MD

From the Cardiac Unit, University Hospital Morales Meseguer, Murcia, Spain.

Correspondence to Dr Andrés Carnero-Varo, Unidad de Cardiología, Hospital Universitario Morales Meseguer, Avda Marqués de los Vélez s/n, 30.008, Murcia, Spain. E-mail matiasperez@medynet.com

	Introduction

 
A70-year-old man with a history of rheumatic mitral stenosis and valve replacement was admitted to our hospital because of near-syncope. A 12-lead ECG demonstrated atrial fibrillation with a ventricular response of 35 bpm. Evaluation with a 24-hour Holter monitor showed many episodes of prolonged pauses of >3 seconds. A ventricular-demand pacemaker was implanted to prevent loss of consciousness. A transvenous pacemaker electrode (Biotronik SX 53-BP) was inserted via the right subclavian vein and connected to the pulse generator (Biotronik Dromos SR) implanted subcutaneously in the right subclavian area (Figures 1 and 2). The patient did well until 1 month after implantation, when he presented again with near-syncope. Evidence of pacemaker activity on the ECG was absent even after the application of a magnet on the pulse generator. A chest radiograph showed the lead coiling around the pulse generator (Figure 3). A new surgical procedure was urgently performed. During reimplantation, the pacemaker lead was easily uncoiled, repositioned, and carefully fixed to the fascia. The electrode was connected to the same pulse generator. It was not necessary to remove any device. During the follow-up period of 20 months, there was no evidence of new complications.

View larger version (120K): [in this window] [in a new window]   Figure 1. Chest radiograph showing a VVI pacemaker correctly implanted after first surgical procedure.

View larger version (109K): [in this window] [in a new window]   Figure 2. Lateral chest radiograph showing electrode correctly positioned in apex of right ventricle.

View larger version (122K): [in this window] [in a new window]   Figure 3. Radiograph demonstrating a pacemaker lead coiling around pulse generator (the "reel syndrome"). Classically, Twiddler's syndrome occurs in obese women with loose, fatty subcutaneous tissue and . . . [Full Text of this Article]