title: Twiddler's syndrome in a patient with a biventricular-defibrillator device.
abstract: A 69-year-old man with previous myocardial infarction and proximal three-vessel coronary artery disease underwent coronary bypass grafting, with an epicardial lead placed on the lateral left ventricular wall during surgery. A cardiac resynchronization therapy-defibrillator (CRT-D) device was subsequently implanted using active right atrial and right ventricular leads, with the pulse generator placed in a pre-pectoral pocket. Four weeks later, the right atrial lead was failing to sense or capture, and chest X-ray revealed it had pulled out of the myocardium and coiled up behind the device; a diagnosis of Twiddler's syndrome was made. Twiddler's syndrome is unusual in patients with CRT-D devices and may cause symptoms such as inappropriate shocks and hiccups. Placement of the pulse generator in a sub-pectoral position may help prevent it.
authors.affiliation: Department of Cardiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Newcastle Road, Stoke on Trent ST4 6QG, UK. f.osman@bham.ac.uk
authors.forename: Faizel
authors.initials: F
authors.lastname: Osman
authors.forename: Ross
authors.initials: R
authors.lastname: Ward
authors.forename: Adrian
authors.initials: A
authors.lastname: Morley-Davies
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*