Leadless pacemaker in Twiddler's syndrome: A case report.

Area of Science:

• Cardiology
• Medical Devices
• Genetics

Background:

• Pacemaker implantation is a common procedure for managing cardiac arrhythmias.
• Lead dislodgement can compromise pacemaker function, necessitating intervention.
• Twiddler syndrome is an uncommon but recognized cause of lead displacement.

Observation:

• A 49-year-old male with Down syndrome experienced pacemaker malfunction 3 months post-implantation.
• The patient presented with high ventricular impedance, loss of sensing, and complete loss of capture.
• Lead dislodgement due to Twiddler syndrome was identified as the cause.

Findings:

• Twiddler syndrome led to dual-chamber pacemaker lead dislodgement in this patient.
• The malfunction resulted in complete loss of pacing capture and sensing.
• Surgical removal of the dislodged device was performed.

Implications:

• This case highlights Twiddler syndrome as a critical differential diagnosis for pacemaker failure.
• It underscores the importance of considering patient behavior and device manipulation.
• Successful implantation of a leadless pacing system offers an alternative in complex cases.