Pacemaker Reel Syndrome Presenting as Recurrent Syncope: A Case Report

An elderly woman presented with recurrent syncope for two weeks. She had undergone a single-chamber permanent pacemaker implantation (PPI) two months ago. At presentation 12-lead electrocardiogram revealed complete heart block. Cinefluoroscopy revealed that the right ventricular (RV) lead had dislodged and was lying in the superior vena cava. On comparison with prior cinefluoroscopy, the pulse generator appeared to have rotated about its transverse axis, with leads coiled around the generator, consistent with Reel syndrome. The right-sided pocket was re-explored. The lead was seen to be coiled on top of the pacemaker generator. Right axillary venous access was taken, and an active fixation lead was implanted in the RV. She was discharged with instructions regarding careful arm movement.