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Removing the Twiddling stigma: spontaneous lead retraction without patient manipulation
Joshua M Cooper1, Stavros Mountantonakis, Melissa R Robinson
1Cardiovascular Division, Department of Internal Medicine, University of Pennsylvania Health System, 9 Founders Pavilion, Philadelphia, PA 19104, USA. joshua.cooper@uphs.upenn.edu
Summary
Newly implanted pacemaker or implantable cardioverter-defibrillator (ICD) leads can retract spontaneously, even without patient manipulation. Securely suturing leads is crucial to prevent this dislodgement, known as Twiddler's Syndrome.
Area of Science:
- Cardiology
- Medical Devices
- Implantable Electronic Devices
Background:
- Pacemaker and implantable cardioverter-defibrillator (ICD) leads require several weeks to fully scar into place after implantation.
- Lead dislodgement, often termed 'Twiddler's Syndrome,' is a known complication, typically attributed to patient manipulation of the implanted device.
Observation:
- A case study involving a 27-year-old male patient who underwent submuscular dual-chamber ICD implantation.
- The patient experienced complete retraction of the atrial lead, while the ventricular lead remained in place.
- This retraction occurred without any reported conscious or unconscious manipulation of the device pocket by the patient.
Findings:
- Lead retraction can occur spontaneously, independent of patient manipulation, during normal physiological movements such as arm movement.
- The case highlights that not all leads within a dual-chamber system may be equally susceptible to spontaneous retraction.
- The mechanism of spontaneous retraction suggests that factors beyond patient interaction can contribute to lead dislodgement.
Implications:
- Emphasizes the critical importance of firmly securing all implanted leads using their suture sleeves to minimize the risk of retraction.
- Suggests a need to re-evaluate the prevailing understanding of Twiddler's Syndrome and its causative mechanisms.
- Highlights the potential for lead dislodgement even in the absence of overt patient interference, underscoring the need for robust lead fixation techniques.
