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Europace Advance Access originally published online on February 1, 2008
Europace 2008 10(3):366; doi:10.1093/europace/eum265
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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 single-chamber implantable cardioverter defibrillator

Aleksandra Czepiel*, Ewa Makowska and Piotr Kulakowski

Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Grenadierow 51/59, Warsaw 04-073, Poland

Manuscript submitted 3 October 2007. Accepted after revision 7 November 2007.

* Corresponding author. Tel: +48 22 871 12 55; fax: +48 22 810 17 38. E-mail address: aczepiel{at}kkcmkp.pl; aczepiel{at}gmail.com

Key Words: Twiddler's syndrome, Implantable cardioverter-defibrillator

A 67-year-old, obese, Caucasian female with a history of ischaemic dilated cardiomyopathy and ventricular fibrillation, underwent a single-chamber implantable cardioverter defibrillator (ICD) with a screw, in ventricular lead implantation. Appropriate sensing, pacing, and defibrillation thresholds were obtained at implantation. A chest X-ray after implantation demonstrated a proper lead position. The patient had no history of psychiatric disease. The patient showed-up for a 6-month follow-up visit, having one ICD discharge just 2 days before. The ICD interrogation revealed inappropriate therapy due to sensing problems. During device testing, no ventricular capture was possible, and atrial pacing was achieved at the maximal output. The lead impedance was high (1350 {Omega}, previously was 590 {Omega}). A chest X-ray revealed retraction of the lead to the right atrium and its extreme twiddling in the generator pocket (Figure1A), confirmed intra-operatively (Figure 1B). The lead was damaged with insulation defect at the proximal segment. The lead was safely removed and a new one implanted. The existing ICD was placed in a pocket and sutured tightly to the underlying muscle for stability.


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  		Figure 1 (A) Chest X ray shows twiddling of the lead in the generator's pocket; (B) Lead twiddling confirmed intraoperatively.

 
Conflict of interest: none declared.


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This Article
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