Reverse Ratchet Syndrome With Intracardiac Looping.

Intracardiac lead looping developed 7 years after ICD implantation due to reverse Ratchet syndrome. Despite marked radiographic abnormalities, device parameters remained stable and the patient was asymptomatic. Inadequate fixation of the generator and lead sleeves likely contributed to lead advancement. Surgical revision with secure fixation prevented recurrence, highlighting the importance of proper device fixation and long-term imaging follow-up to detect delayed lead malposition.