title: Twiddling with an implantable cardioverter-defibrillator.
abstract: A 64-year-old woman underwent implantation of a single-chamber implantable cardioverter-defibrillator. The active fixation lead was positioned in the right ventricular apex and the generator in a left pre-pectoral pocket. Device interrogation 4weeks after implantation revealed inappropriate sensing and failure of pacing. A chest X-ray showed the entire lead coiled behind the device. The patient admitted manipulating the device and a diagnosis of Twiddler's syndrome was made. After repositioning the lead, the generator was re-located in the sub-pectoral position to help prevent recurrence by reducing the ability to externally manipulate the device.
authors.affiliation: Cardiovascular Centre, OLV Hospital, Aalst, Belgium. conorjmccann@hotmail.com
authors.forename: Conor J
authors.initials: CJ
authors.lastname: McCann
authors.forename: Roel
authors.initials: R
authors.lastname: Beelen
authors.forename: Peter
authors.initials: P
authors.lastname: Geelen
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D013902:Radiography, Thoracic; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000209:etiology / Q000517:prevention & control