Serial Case of Twiddler Syndrome
Date
2018-10-02Author
Wulandari, Pipiet
Raharjo, Sunu B
Hanafy, Dicky A
Haryati, Lina
Yuniadi, Yoga
Metadata
Show full item recordAbstract
Background: Twiddler syndrome is an infrequent but potentially dangerous
complication of device therapy for dysrhythmias. This syndrome results from
manipulation of implanted pulse generator by the patient, leading to traction and
subsequent lead dislodgement. It can also occur spontaneously. It has been increasingly
reported
with
pacemaker
or
implantable
cardioverter-defibrillators
(ICDs).
In
this
reports,
we
describe
two
patients
with
Twiddler
syndrome
with
substantial
retraction
of their lead who denied any manipulation of their device.
Case
Illustration:
The
first
patient
was
a
56
year-old
man
with
single-chamber
ICD
due
to
dilated
cardiomyopathy
(DCM)
with
congestive
heart
failure
and
severe
systolic
left ventricular dysfunction (ejection fraction 18%). The dislodged lead
causing rhythmical twitching of left pectoral muscles and abdominal pulsations.
The second patient was a 69 year-old man with dual-chamber pacemaker due
to total atrioventricular block with normal systolic left ventricular function (ejection
fraction 70%). It manifested as dyspnea on effort, and he also underwent
pacemaker implantation. They underwent primary devices implantation at April
2016 and reposition of generators and its leads in December 2016. The first and
second patients denied of manipulating the generator of ICD or pacemaker and
rotated their left arm and right arm, respectively, after implantation.
Summary: Other unconscious arm abduction during sleep or increased muscular
activity of the shoulder and arm might have led to repetitive motions within the
pocket and dislodge the device. Adequate individualized patient and family education
and
regular
evaluation
every
6
month
of
the
leads
position
with
fluoroscopy
or
chest X-ray
is advisable.
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