Although Reel syndrome present early after de novo implant (usually within one month) compared to other varieties of LMD, our patient exhibited features after an unusually long duration (5 years from original implant). Besides the technical aspects focused in preventing LMD such as adequate lead slack at implant time, careful suture sleeve fixation using non-absorbable sutures, appropriately matching pocket etc., routine follow up and device interrogation are vital in early diagnosis of LMD. Unfortunately, the patient had lost follow up, potentially leading to excessive battery use (draining high currents for RA and LV leads with inappropriate captures).