[Twiddler's syndrome in a patient with implantable cardioverter defibrillator: an avoidable complication?]

Area of Science:

• Cardiology
• Medical Device Complications
• Radiology

Background:

• Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening cardiac arrhythmias.
• While beneficial, ICDs carry risks, including uncommon but severe complications.
• Twiddler's syndrome is a recognized, albeit rare, complication associated with ICDs.

Observation:

• Twiddler's syndrome involves the mechanical manipulation of the ICD and its leads.
• This manipulation often stems from repetitive, unconscious, or intentional patient behaviors.
• The syndrome can lead to lead dislodgement, device malfunction, and significant patient harm.

Findings:

• Early identification of specific patient behaviors or 'attitudes' is key.
• Predisposed patients may exhibit unique patterns of movement or interaction with their device.
• Radiological surveillance can detect lead migration or other physical changes associated with the syndrome.

Implications:

• Proactive identification of at-risk patients is essential for preventing Twiddler's syndrome.
• Implementing regular radiological follow-up can aid in the early detection of mechanical complications.
• This approach supports the primary prevention of a potentially life-threatening ICD complication, improving patient safety.