A Potentially Lethal Dysfunction of a Subcutaneous Implantable Cardiac Defibrillator: "The Phantom Menace"?

In this article we describe, to our knowledge, the first case of a potentially lethal dysfunction of a subcutaneous implantable cardioverter-defibrillator (S-ICD). A 70-year-old patient underwent primary S-ICD implantation. Nine months after, communication could not be established with the device. Chest radiography revealed that the lead had moved and wrapped around the generator. After equipment extraction, we observed the lead wound around the sagittal axis of the generator. A burn mark with melted metal was found inside the generator. Our hypothesis is an electric arc occurred between the retracted lead and the generator. This could be the first reported Reel syndrome secondary to S-ICD implantation.