Late Twiddler’s Syndrome in a Nigerian on a Demand Pacemaker

Abstract

A 75 year old woman with unipolar ventricular pacemaker presented with cough, difficulty breathing and dizziness. An initial electrocardiogram (ECG) showed atrial fibrillation, incomplete right bundle branch block with no pacemaker spikes. The chest radiograph revealed twisting of the leads at various points. She was managed conservatively with anti-failure drugs and monthly ECG. The pacemaker could not be interrogated due to logistic reasons. However, the ECG during the 8th month of follow-up showed pacemaker spikes and complete left bundle branch block pattern suggestive of spontaneous return of pacemaker function.