Twiddling with an implantable cardioverter-defibrillator

Area of Science:

• Cardiology
• Medical Devices
• Patient Safety

Background:

• Implantation of a single-chamber implantable cardioverter-defibrillator (ICD) in the right ventricular apex.
• Generator placed in a left pre-pectoral pocket.
• Post-implantation monitoring is crucial for device function.

Observation:

• Device interrogation revealed inappropriate sensing and pacing failure 4 weeks after implantation.
• Chest X-ray demonstrated the ICD lead coiled behind the generator.
• Patient self-reported manipulating the implanted device.

Findings:

• Diagnosis of Twiddler's syndrome confirmed.
• Successful lead repositioning performed.
• Generator relocated to a sub-pectoral position to mitigate recurrence.

Implications:

• Twiddler's syndrome can compromise ICD efficacy.
• Preventive strategies include optimizing lead placement and generator pocket choice.
• Patient education on device care is essential to avoid complications.