Twiddler's syndrome in a patient with a biventricular-defibrillator device

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Abstract

A 69-year-old man with previous myocardial infarction and proximal three-vessel coronary artery disease underwent coronary bypass grafting, with an epicardial lead placed on the lateral left ventricular wall during surgery. A cardiac resynchronization therapy-defibrillator (CRT-D) device was subsequently implanted using active right atrial and right ventricular leads, with the pulse generator placed in a pre-pectoral pocket. Four weeks later, the right atrial lead was failing to sense or capture, and chest X-ray revealed it had pulled out of the myocardium and coiled up behind the device; a diagnosis of Twiddler's syndrome was made. Twiddler's syndrome is unusual in patients with CRT-D devices and may cause symptoms such as inappropriate shocks and hiccups. Placement of the pulse generator in a sub-pectoral position may help prevent it. © The Author 2008.

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Osman, F., Ward, R., & Morley-Davies, A. (2008). Twiddler’s syndrome in a patient with a biventricular-defibrillator device. Europace, 10(3), 364–365. https://doi.org/10.1093/europace/eum292

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