title: Twiddler's syndrome variants in ICD patients.
abstract: Three cases of twiddler's syndrome in patients with an abdominally implanted cardioverter defibrillator (ICD) and an endocardial lead system are reported. The condition was detected when an increase in pacing threshold or lead impedance was noted at routine follow-up. Successful revision was possible in all patients; however, a recurrence in one patient necessitated removal of the device. Elderly female patients with some degree of obesity appear most susceptible. Minimizing pocket size and suturing of the device to the fascia should decrease the chance of developing this problem.
authors.affiliation: Harvard Thorndike Electrophysiology Service, Cardiology Division, Beth Israel Hospital, Boston, Massachusetts 02215, USA.
authors.forename: N G
authors.initials: NG
authors.lastname: Boyle
authors.forename: F
authors.initials: F
authors.lastname: Anselme
authors.forename: K M
authors.initials: KM
authors.lastname: Monahan
authors.forename: P
authors.initials: P
authors.lastname: Beswick
authors.forename: C D
authors.initials: CD
authors.lastname: Schuger
authors.forename: J
authors.initials: J
authors.lastname: Zebede
authors.forename: M E
authors.initials: ME
authors.lastname: Josephson
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012399:Rotation; D013577:Syndrome