Reel syndrome, a diagnostic conundrum: a case report

Area of Science:

• Cardiology
• Neurology
• Radiology

Background:

• Permanent pacemaker (PPM) insertion can lead to rare complications like lead dislodgement and failure.
• Syndromes such as Reel's, Twiddler's, and Ratchet syndrome are uncommon causes of pacemaker malfunction, characterized by specific X-ray findings.
• Patient symptoms may be misleading due to pacemaker lead stimulation of adjacent anatomical structures.

Observation:

• A 77-year-old female presented with abdominal wall pulsations, pain, and lower limb jerking post-PPM insertion.
• Reel syndrome was diagnosed via chest X-ray, with electrocardiogram revealing inappropriate pacing.
• Pacemaker deactivation immediately resolved symptoms, necessitating urgent lead repositioning.

Findings:

• Pacemaker lead dislodgement can manifest with non-cardiac symptoms, mimicking other conditions.
• Unconventional presentations of lead stimulation underscore the need for a broad differential diagnosis.
• Prompt identification of lead dislodgement is key to effective management.

Implications:

• Considering pacemaker lead complications is vital for diagnosing unexplained neuromuscular symptoms in PPM patients.
• A systematic diagnostic approach for patients with PPMs should include lead dislodgement.
• Timely intervention, including device deactivation and lead repositioning, prevents severe complications.