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Review
. 2021 Nov 16;15(2):103-105.
doi: 10.17925/HI.2021.15.2.103. eCollection 2021.

An Unusual Cause of Pacemaker Lead Displacement: 'Reverse Ratchet' Syndrome

Haytham Enab  1 , Colin Cunnington  1 , Amir Zaidi  1
Affiliations
Review

An Unusual Cause of Pacemaker Lead Displacement: 'Reverse Ratchet' Syndrome

Haytham Enab et al. Heart Int. .

Abstract

Lead displacement is a common complication of pacemaker device implantation, often resulting in prolonged hospital stays and increased costs. The frequency of long-term lead displacement ranges between 1.8% and 8.0%. In our case, the patient did not present any symptoms and the lead displacement was seen at a relatively late stage. During a routine pacemaker follow up, it was noted that the right ventricular (RV) threshold had increased and deteriorated over time. The pacemaker box had rotated anticlockwise and the RV lead had developed a loop that eventually led to its retraction from the RV implantation position into the pulmonary artery. The patient was asymptomatic; however, he underwent RV lead revision. Patient education, opening an appropriate pocket for the size of the generator, fixing the sleeves to an appropriate tightness and securing the battery with a strong suture all can be used to avoid lead displacement.

Keywords: Permanent pacemaker displacement; Permanent pacemaker implantation; Ratchet Syndrome; pulmonary artery.

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Conflict of interest statement

Disclosures: Haytham Enab, Colin Cunnington and Amir Zaidi have no financial or non-financial relationships or activities to declare in relation to this article.

Figures

Figure 1:
Figure 1:. Chest X-ray taken in August 2017, after device implantation
Figure 2:
Figure 2:. Chest X-ray taken in May 2018, with the lead loop noticed
Figure 3:
Figure 3:. Chest X-ray showing the right ventricular lead displaced into the pulmonary artery
See this image and copyright information in PMC

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