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Europace Advance Access originally published online on January 12, 2008
Europace 2008 10(3):364-365; doi:10.1093/europace/eum292
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

ICDS

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

Faizel Osman*, Ross Ward and Adrian Morley-Davies

Department of Cardiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Newcastle Road, Stoke on Trent ST4 6QG, UK

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.

Key Words: Twiddler's syndrome, Cardiac resynchronization therapy, Implantable defibrillator

* Corresponding author. Tel: +44 1782 55305. E-mail address: f.osman{at}bham.ac.uk

Manuscript submitted 1 November 2007. Accepted after revision 10 December 2007.


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