Early development of pacemaker Reel syndrome in an elderly patient with cognitive impairment

Reel syndrome is a rare form of Twiddler’s syndrome and is characterized by rotation of permanent pacemaker on its transverse axis and rolling of the electrode around the generator. An 83-year-old man with severely impaired mental status, agitation, and uncontrolled movement of extremities underwent pacemaker implantation for symptomatic atrial fibrillation. The pacemaker generator was fixed to the pectoral fascia with nonabsorbable ligatures. On the next day, failure to capture the ventricle was noted. Fluoroscopic examination showed coiling of the electrode around the generator. During urgent intervention, the ligature of the generator was observed to be released from the pectoral fascia. The pacemaker lead was not damaged; therefore, the same lead was re-implanted, connected to the generator, and carefully fixed to the pectoral fascia. The patient showed rapid clinical improvement together with his mental status. No abnormality was detected during three months of follow-up. Patients with impaired consciousness, children, and older persons require a close follow-up because of their propensity to this serious and life-threatening complication.