Reel Syndrome--the Ratchet mechanism.

Twiddler's Syndrome and Reel Syndrome are potentially harmful lead-related complications in patients with implantable defibrillators and pacemakers. Twiddler's Syndrome is caused by device rotations around the devices long axis. A ratchet mechanism, possibly involving lead fixation sleeves and not device rotations around the transverse axis is suggested to be responsible for the Reel Syndrome. No detailed information about the underlying mechanisms of the Reel Syndrome is available. A case of a patient with a CRT-D and Reel Syndrome is reported; the mechanisms making the Reel Syndrome possible are illustrated and discussed.