Interv Akut Kardiol. 2010;9(1):32-36

Unusual dislocation of atrial and left ventricular electrodes of a biventricular implantable defibrillator

Jolana Lipoldová, Miroslav Novák, Tomáš Vykypěl, Ivo Dvořák

I. interní kardioangiologická klinika, FN u sv. Anny, Brno

Authors present a case of 46-year old woman after biventricular implantable defibrillator (ICD) implantation. Remote monitoring system

(Biotronik Home Monitoring) transferred intracardial electrogram of multiple episodes of supraventricular tachycardia, evaluated by the

physician to be sinus tachycardia. Betablocker dosage was increased but without effect. Two and half months after implantation, Home

Monitoring system alerts abnormal increase of left ventricle lead impedance. Intracardial electrogram of formerly mentioned episodes

show intermittent loss of left ventricular sensing. The patient arrived to extra-follow-up 4 months after implantation due to family problems.

X-rays show left ventricle lead dislodgement to ICD pocket and atrial lead rectified in tension being considered the cause of atrial

arythmogenicity. Taking into account the stable position of defibrillation lead and negative history of generator manipulation in the

pocket, we think it is not a form of twiddler’s syndrome but so-called ratchet syndrome. This means, the dislocation (or retraction) was

caused by one-way-movement of affected leads in pocket fixation. This form of dislocation is very rare and caused probably by notso-

tight fixation of the leads before entering venous system. The problem was resolved by implantation of new left ventricle and atrial

leads. Home Monitoring system is appropriate for early detection in such cases.

Keywords: twiddler’s syndrome, reel syndrome, ratchet syndrome, lead dislocation, lead retraction

Published: March 1, 2010  Show citation