Twiddler's syndrome complicating a transvenous defibrillator lead system

Twiddler's syndrome is a rare complication seen in patients with implanted pacemakers or defibrillators. The condition typically presents with device malfunction and occurs when the patient either consciously or unconsciously twists and rotates the implanted device in its pocket, resulting in torsion and dislodgement of the implanted lead. A case of twiddler's syndrome involving a transvenous defibrillation lead and an abdominally implanted defibrillator is described. This is the first report of this complication with this particular lead. The patient in this report was a middle-aged obese diabetic woman who presented 7 months after defibrillator implantation with device noncapture and intermittent nonsensing. Review of the literature reveals that the majority of patients with this complication are middle-aged obese women with a defibrillator pocket that exceeds the size of the defibrillator. Treatment measures are discussed both for the patient with this complication and for the patient at increased risk for its occurrence.