A Rare Case of Very Early Pacemaker Twiddler's Syndrome

Area of Science:

• Cardiology
• Medical Devices
• Patient Safety

Background:

• Twiddler's syndrome is a rare complication of cardiac pacemakers.
• It typically involves lead dislodgement caused by patient manipulation.
• Diagnosis usually occurs within the first year post-implantation.

Observation:

• This report details a case of Twiddler's syndrome diagnosed within 48 hours of permanent pacemaker implantation.
• The patient's passive fixation of the ventricular lead contributed to the lead dislodgement.
• The syndrome was effectively managed by switching to active fixation of the device leads.

Findings:

• Early-onset Twiddler's syndrome can occur within hours of pacemaker implantation.
• Passive lead fixation may increase the risk of lead dislodgement in susceptible patients.
• Active fixation of pacemaker leads is a reliable method to prevent lead dislodgement.

Implications:

• This case highlights the importance of considering Twiddler's syndrome even in the immediate post-implantation period.
• Active fixation of pacemaker leads should be strongly considered to mitigate the risk of Twiddler's syndrome.
• Implementing active fixation strategies can improve patient safety and reduce pacemaker-related complications.