[Twiddler's syndrome in a left pectoral implanted defibrillator]

Area of Science:

• Cardiology
• Medical Devices
• Surgical Complications

Background:

• Twiddler's syndrome is a rare but significant complication post-pacemaker or defibrillator implantation.
• It involves spontaneous rotation of the implanted device generator within the subpectoral pocket.
• This rotation can lead to lead dislodgement and device malfunction.

Observation:

• A case of a 78-year-old man presenting with exit block 7 months after defibrillator implantation is detailed.
• The cause was identified as a 15-fold rotation of the defibrillator generator around its axis.
• This rotation resulted in the dislocation of the defibrillator's electrode.

Findings:

• The study verified generator rotation as the cause of the exit block.
• Dislocation of the defibrillator electrode was a direct consequence of the generator's rotation.
• The patient experienced a device malfunction due to lead displacement.

Implications:

• Secure fixation of pacemaker/defibrillator electrodes and generators is critical for preventing Twiddler's syndrome.
• Particular attention should be paid to patients with loose subcutaneous fatty tissue.
• Preventing this rare complication ensures device longevity and patient safety.