title: [Twiddler-Syndrome in a subpectoral implanted unipolar cardioverter-defibrillator].
abstract: Twiddler's syndrome is a rare complication in patients with pacemakers. We report this very rare syndrome in a patient with pectoral implanted unipolar cardioverter defibrillator. This syndrome was detected because the patient presented in the 3 month routine visit an exitblock with an increased pacing impedance. The defibrillation threshold remained unchanged. The chest x-ray revealed an inferolaterally migrated generator with a multiply rotated lead. The intraoperative exploration showed a generator which was rotated nine-fold around its longitudinal axis with a multiple twisted unipolar lead. The lead was substituted and the aggregate fixed with a suture to the underlying muscle fascia. An atrophy of the pectoralis muscle was found in this patient which previously resulted from a long hospital stay. This atrophy was identified as a possible risk factor for the development of Twiddler's syndrome. This report illustrates that Twiddler's syndrome, a rare complication in patients with pectoral ICD, may become a significant problem in these patients as it is for pacemaker patients but with more serious possible consequences.
authors.affiliation: Medizinische Klinik III Universität Tübingen.
authors.forename: C
authors.initials: C
authors.lastname: Mewis
authors.forename: V
authors.initials: V
authors.lastname: Kühlkamp
authors.forename: V
authors.initials: V
authors.lastname: Dörnberger
authors.forename: K
authors.initials: K
authors.lastname: Kalighi
authors.forename: L
authors.initials: L
authors.lastname: Seipel
mesh_terms: D000368:Aged; D001284:Atrophy / Q000209:etiology; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005547:Foreign Bodies / Q000209:etiology; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D008297:Male; D010369:Pectoralis Muscles / Q000473:pathology*; D012307:Risk Factors
vernacular_title: Twiddler-Syndrom bei einem subpektoral implantierten unipolaren Cardioverter-Defibrillator.