title: Twiddler's syndrome and pectoral stimulation in a patient with dual-site unipolar atrial pacing.
abstract: Twiddler's syndrome is a rare condition of pacemaker rotation; when associated with unipolar pacing it could provoke extracardiac muscular stimulation. We report a case of an obese woman who unintentionally reversed her triple-chamber, dual-site unipolar atrial pacemaker, implanted for the prevention of paroxysmal atrial fibrillation. The extracardiac pectoral stimulation was due to unipolar atrial stimulation. The polarity mode was not programmable and output reduction was unsuccessful. Thus, the problem was resolved noninvasively by means of external manual rotation of the pacer. At 24 months of follow-up, the patient was still free of symptoms.
authors.affiliation: Cardiology Division, University of Piemonte Orientale, Novara, Italy. occhetta@r-j.it
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.forename: Miriam
authors.initials: M
authors.lastname: Bortnik
authors.forename: Gabriella
authors.initials: G
authors.lastname: Francalacci
authors.forename: Andrea
authors.initials: A
authors.lastname: Magnani
authors.forename: Laura
authors.initials: L
authors.lastname: Plebani
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000175:diagnosis* / Q000628:therapy*