Most of the time when a pacemaker or ICD lead retracts, or the device itself rotates, it is due to inadequate fixation during the implant procedure. Random arm movements result in ratcheting (preferential unidirectional movement). Occasionally, patients do manipulate devices due to discomfort.
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I always tie down my devices, part of my hope is that it will keep patients from doing this. Curious what you think about that?