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Introduction: Reel syndrome resulting in lead dislodgement is a rare, but well-known complication of cardiac device implantation. Therefore, it has to be considered in case of device dysfunction. Case description: We present the case of a 64-year-old male patient who visited our ward following an ICD shock. He had heart failure with reduced ejection fraction, and had a CRT-D device implanted 2 years before. The 12-lead ECG showed a septal pacemaker rhythm. Device interrogation verified adequate ICD therapy, with left ventricular sensing and capture failure. Chest X-ray showed optimal right atrial and defibrillator lead position. The left ventricular lead was not present near the heart. Our patient reported that he regularly manipulated the area around the device. During the pacemaker system revision, the diagnosis of isolated coronary sinus lead Reel syndrome was verified. We removed the old lead and implanted a new one in a good position in a lateral vein. Discussion: Thorough patient education and regular check-ups for patients living with permanent pacemakers and implantable cardioverter defibrillators are essential. Migration of the device can occur in some rare cases, leading to lead dislodgement. We can reduce the risk of these complications by appropriately anchoring leads and generators.

We present the case of a 52-year-old female patient on optimal medical therapy (OMT) for heart failure with severely reduced ejection fraction. She was diagnosed with dextrocardia and congenital corrected transposition of the great arteries (ccTGA) by echocardiography. Despite 3 months of OMT and a persisting NYHA II functional state, she was referred for primary prevention ICD implantation. At admission echocardiography revealed a hypertrophic systemic ventricle with an ejection fraction of 27%. Cardiac CT confirmed ccTGA, dextrocardia, a normal extracardiac and epicardial venous system. Coronary artery disease was excluded. Our team opted for left-sided VDD-ICD implantation in case of a need for AV-synchronous pacing and to enhance arrhythmia discrimination. An active fixation shock lead was placed in the mid-septal region of the functional right ventricle. The defibrillation threshold test (DFT) was successful at 20 J. No periprocedural complications were observed. At the 12-month ambulatory visit, device interrogation showed good function, no detected arrhythmias, and no antitachycardia therapy was delivered. Preoperative imaging is essential prior to any invasive cardiac procedure in patients with congenital heart disease. Performing a DFT test at adult congenital heart disease patients may be reasonable.

In case of pacemaker implantation, axillary vein puncture remains a less common technique in both domestic and foreign institutions. In our article, we present the implementation of this method in a center where there was no prior experience with it. During our study, dividing the patients into two groups, we retrospectively compared the success and complication rates of subclavian and axillary punctures. Based on our results, introducing the electrode through the axillary vein is equally effective and safer than subclavian puncture. It can be easily mastered even without specific training by an electrophysiologist experienced in subclavian vein cannulation.