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An uncommon twist on Twiddler's syndrome
Ronan G Ali1, Leenhapong Navaravong, Jiang Cui
1Department of Medicine, Baystate Medical Center-Tufts University School of Medicine, USA.
Connecticut Medicine
|June 8, 2012
Summary
Twiddler's syndrome, a rare cause of implantable cardioverter-defibrillator (ICD) dysfunction, involves lead coiling around the generator. This case highlights solitary atrial lead rotation in an ICD patient, successfully managed with lead revision and generator repositioning.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Twiddler's syndrome is a rare complication of pacemaker and implantable cardioverter-defibrillator (ICD) implantation.
- It is characterized by the manipulation of the implanted device generator, leading to lead dislodgement or coiling.
Purpose of the Study:
- To describe a rare case of Twiddler's syndrome involving an implantable cardioverter-defibrillator (ICD).
- To illustrate the clinical presentation, diagnosis, and successful management of solitary atrial lead rotation in an ICD patient.
Main Methods:
- A case report of a 44-year-old woman presenting with left arm twitching three months post-ICD implantation.
- Diagnostic imaging (chest radiograph) to identify lead dislodgement and generator rotation.
- Management involved adjusting ICD pacing mode and subsequent surgical revision.
Main Results:
- The patient presented with symptoms consistent with Twiddler's syndrome, specifically solitary atrial lead dislodgement and ICD generator rotation.
- Switching the ICD pacing mode to VVI successfully halted the muscle contractions.
- Atrial lead revision and generator repositioning were performed without complications.
Conclusions:
- Twiddler's syndrome can occur with implantable cardioverter-defibrillators (ICDs), even with isolated lead rotation.
- Prompt diagnosis and appropriate management, including pacing mode adjustment and surgical intervention, can effectively resolve the condition.
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