Unique presentation of Twiddler’s syndrome

Abstract

We present a rare case of Twiddler's syndrome diagnosed in an asymptomatic patient on a routine follow up. This case reiterates the need for frequent monitoring of the implanted device. In addition, it was detected 4 years after implantation of an automatic implantable cardioverter defibrillator. This late representation is extremely uncommon.

Twiddler's syndrome: An unusual cause of repeated shocks by implantable cardioverter-defibrillator in an asymptomatic patient

“…Most cases occur in the 1 st year after implantation of the defibrillator;[67] however, twiddler's syndrome can still occur after that. [8] The established guidelines for ICD placement follow-up are recommended after 72 h from placement and then after 2–12 weeks. Thereafter, in-person or remote follow-ups in 3–6 months can be performed.…”

“…[9] These follow-up intervals are assigned to identify dysfunctioning ICDs. Twiddler's syndrome can be asymptomatic[8] or represented with various symptoms depending on the final site of the displaced lead. Most symptoms occur due to missed capture, stimulation of nearby structures, or improper exaggerated response to an input.…”

Twiddler’s Syndrome and Neuromodulation-Devices: A Troubled Marriage

“…bending over) might occur as well. Although the condition has been amply documented in the cardiologic literature (17)(18)(19)(20)(21)(22), the phenomenon remains underexplored in the rapidly developing field of neuromodulation. Indeed, only recently a handful of cases with Twiddler's syndrome have been published describing patients with DBS systems implanted in the pectoral region (1,(23)(24)(25)(26)(27).…”

Twiddler Syndrome: A Rare Complication of Pacemaker Lead Placement

“…The diagnosis of Twiddler Syndrome can be challenging as it is often asymptomatic and can present with a wide range of symptoms such as device failure, sensing disturbances, and atrial or ventricular arrhythmias. 8 Therefore, it is important for clinicians to have a high index of suspicion in patients with pacemakers, especially those who have a history of manipulating their device.…”