title: Unusual "ratchet syndrome": spontaneous lead retraction after a generator exchange.
abstract: A 72-year-old female with idiopathic dilated cardiomyopathy underwent a generator exchange for a cardiac resynchronization therapy defibrillator with a full-pocket capsulectomy. The lead position after the operation was identical to that before the operation on the chest X-ray. After 4 months, a subacute exacerbation of her heart failure was caused by cardiac resynchronization therapy failure due to a dislodgement of the left ventricular lead. An aggressive adhesiotomy of the connective tissue around the leads made it possible for the lead to retract by a ratchet-like movement through the suture sleeve, so-called "ratchet syndrome", after the generator exchange.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan, koichiro@qf6.so-net.ne.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ejima
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.forename: Bun
authors.initials: B
authors.lastname: Yashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nuki
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Manaka
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable; D020878:Device Removal; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011474:Prosthesis Design; D016896:Treatment Outcome; D016277:Ventricular Function, Left