scholarly journals Twiddler's syndrome detected by patient's complaint of implantable cardioverter-defibrillator rotation in the subcutaneous pocket

2012 ◽  
Vol 28 (4) ◽  
pp. 239-241 ◽  
Author(s):  
Hirokazu Konishi ◽  
Takashi Tokano ◽  
Yuji Nakazato ◽  
Sayaka Komatsu ◽  
Satoru Suwa ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome

Twiddler's syndrome with the implantable cardioverter-defibrillator

1992 ◽  
Vol 123 (4) ◽  
pp. 1079-1082 ◽  
Author(s):  
Davendra Mehta ◽  
Marc Lipsius ◽  
Rajesh S. Suri ◽  
Ryszard B. Krol ◽  
Sanjeev Saksena
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome

scholarly journals A Case of Subcutaneous Implantable Cardioverter-Defibrillator Twiddler's Syndrome

2020 ◽  
Author(s):  
Chengyue Jin ◽  
Daniel Frenkel ◽  
Rhadamas Rojas ◽  
Jason Jacobson ◽  
Sei Iwai ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome

scholarly journals Twiddler’s Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 299-300
Author(s):  
Jason Lesnick ◽  
Benjamin Cooper ◽  
Pratik Doshi
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Implantable Cardioverter Defibrillator ◽  
Chest Radiograph ◽  
Rare Condition ◽  
Operative Intervention ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome ◽  
Automatic Implantable Cardioverter Defibrillator

Twiddler’s syndrome refers to a rare condition in which a pacemaker or automatic implantable cardioverter-defibrillator (AICD) malfunctions due to coiling of the device in the skin pocket and resultant lead displacement. This image is the chest radiograph (CXR) of a 54-year-old male who presented to the emergency department with chest pain five months after his AICD was placed. The CXR shows AICD leads coiled around the device and the absence of leads in the ventricle consistent with Twiddler’s syndrome. Patients with twiddler’s syndrome should be admitted for operative intervention.

Abstract 15480: Twiddler’s Syndrome in a Subcutaneous Implantable Cardioverter-Defibrillator

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chengyue Jin ◽  
Jason Jacobson ◽  
Sei Iwai ◽  
Aileen M Ferrick
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Pulse Generator ◽  
Rare Complication ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Surface Ecg ◽  
Patient Reported ◽  
History Of ◽  
Twiddler’S Syndrome

Introduction: Twiddler’s syndrome refers to deliberate or unintentional twisting of pulse generator in device pocket resulting in lead migration, which can present as malfunction of pacemaker or implantable cardioverter-defibrillator (ICD). In the past 50 years, twiddler’s syndrome with transvenous ICD and pacemaker has been well-described and thoroughly studied. However, there are very little data on twiddler’s syndrome with subcutaneous ICD (S-ICD). Case presentation: The patient is a 50-year-old male with a past medical history of hypertrophic cardiomyopathy, cardiac MRI showing left ventricular hypertrophy with a wall thickness of 24 mm, non-sustained ventricular tachycardia and evidence of late gadolinium enhancement scar, who underwent implantation of S-ICD for primary prevention. First follow-up 2 weeks post-implant showed appropriate device function. Two weeks later, remote monitor documented atrial fibrillation and ICD shocks. Surface ECG showed reduced R wave and delivered shock impedance was 7 ohms. Patient reported no symptoms and was clapping hands to music when it occurred. Chest X-Ray revealed S-ICD lead dislodged and retracted with coiling around the generator in the left lateral chest wall (Figure 1). Subsequently patient underwent lead revision and device replacement. To reduce the risk of future dislodgement, during re-implantation, the tip of the ICD lead was secured with 0-Silk. Conclusion: Twiddler’s syndrome is a rare complication after ICD implantation, not only with transvenous-ICDs but also involving S-ICDs. Risk factors include advanced and younger ages, redundant skin, obesity, oversized pocket, and psychiatric disorder. It can be a potentially dangerous and even fatal due to undetected or unsuccessful therapy for ventricular tachyarrythmias. Therefore, it is of paramount importance to diagnose and intervene early to avoid morbidity and mortality in these patients.

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