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Navarro-Suay, E. López-Soberón, S. Álvarez-Antón, R. Puchades-Rincón de Arellano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Navarro-Suay" "email" => array:1 [ 0 => "r_navarro_suay@yahoo.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "López-Soberón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Álvarez-Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Puchades-Rincón de Arellano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Mixto de Investigación Biosanitaria de la Defensa “IMIDEF”, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Macrodislocación de electrodos de marcapasos cardiaco previo a cirugía por tumor renal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1123 "Ancho" => 2500 "Tamanyo" => 189289 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest radiograph after pacemaker implantation. (B) Chest radiograph showing displacement of the electrode, which is coiled around the device (Reel syndrome).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Reel syndrome is characterised by rotation of the pacemaker generator on its transverse axis with subsequent coiling of the leads around the generator. It differs from Twiddler's syndrome, which involves coiling of the pacemaker lead due to rotation of the pacemaker generator on its long axis, and is more often associated with twisting or fracture of the leads.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It may go unnoticed, but usually manifests with dizziness, syncope, dyspnoea or ECG abnormalities. Chest radiography is the diagnostic method of choice, and treatment consists of reimplantation of the device with adequate fascial fixation and periodic follow-ups.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of an 82-year-old man with a history of hypertension, type 2 diabetes mellitus, dyslipidemia, hypothyroidism, obesity, chronic ischaemic heart disease with two stents, residual ejection fraction of 45%, and slow atrial fibrillation. The latter was corrected with uneventful implantation of a VVI pacemaker 1 month previously with good radiographic follow-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) prior to scheduled right nephrectomy following diagnosis of a kidney tumour. The patient was receiving chronic acetylsalicylic acid, metformin, atorvastatin, bisoprolol, levotyrosine and amiodarone therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">On the day of surgery, during the anaesthesiology checklist performed in the operating room, the patient reported “involuntary” pulsating movements in the abdomen accompanied by general malaise and dyspnoea on mild exertion that he associated with the pacemaker.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After taking his clinical history and performing an ECG and a chest radiograph, we observed that the implanted pacemaker had rotated forcing the electrode to migrate from the right ventricle to the brachiocephalic artery, in the proximity of the left phrenic nerve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The pacemaker was immediately reimplanted under local anaesthesia and sedation, and correct positioning was confirmed on chest radiography. The patient ultimately declined surgery and instead received conservative treatment with periodic follow-up by the Urology and Cardiology Services.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Some studies have observed intraoperative pacemaker- and ICD-related problems in 10% of users of these devices. There are even reports of fatalities thought to be related to these devices, in which inadequate preoperative evaluation and preparation could have played a major role.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The factors associated with Reel syndrome are a large pacemaker pocket, elderly patients with mental illnesses (who may repeatedly manipulate the device), female gender (apparently due to hypermobility of the skin) and obesity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> These factors facilitate rotation of the pacemaker, and can lead to retraction of the electrodes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the pre-operative evaluation of a patient with newly implanted pacemaker it is essential to ask about the onset of new symptoms since implantation of the device, and to assess the integrity and location of the electrodes on chest radiograph.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> A pre-operative chest X-ray should be ordered in all patients with a pacemaker, or at least in those who have symptoms suggestive of pacemaker malfunction.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our case, despite correct implantation of the device, the generator had gradually rotated on its transverse axis. The patient presented several predisposing factors (obesity and advanced age), and his symptoms, which appeared a few weeks after implantation, could be related to aberrant stimulation of the phrenic nerve by the retracted electrode. This highlights the importance of the anaesthesiology evaluation and pre-surgery checklist, which in this case was led to the diagnostic suspicion that was later confirmed by chest X-ray. The recommended treatment was followed in this case, that is, reimplantation and correct fixation of the electrode.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Early detection and treatment of Reel syndrome is essential to avoid perioperative complications secondary to pacemaker dysfunction. Diagnosis of this syndrome is a multidisciplinary task, and this teamwork is essential during the preoperative period.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro-Suay R, López-Soberón E, Álvarez-Antón S, Puchades-Rincón de Arellano R. Macrodislocación de electrodos de marcapasos cardiaco previo a cirugía por tumor renal. Rev Esp Anestesiol Reanim. 2018;65:174–175.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1123 "Ancho" => 2500 "Tamanyo" => 189289 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest radiograph after pacemaker implantation. (B) Chest radiograph showing displacement of the electrode, which is coiled around the device (Reel syndrome).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome de reel: una variante del síndrome de twiddler" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Echevarri" 1 => "A.M. Barón" 2 => "J.C. García" 3 => "J.D. 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