title: Physiotherapy as a Rare Cause of Twiddler's Syndrome in a Patient With an Implanted Cardioverter Defibrillator.
abstract: A 65-year-old male patient with a history of ischemic cardiomyopathy developed ventricular tachycardia resulting in presyncope. An ICD was indicated for secondary prophylaxis of ventricular tachyarrhythmias. A dual chamber ICD was implanted from the right side because insertion of the device from the left side was unfeasible after surgery of a left subscapularis tendon lesion. ICD implantation and testing of defibrillation threshold were uneventful. During early follow-up a progressive increase of the stimulation threshold was detected. On chest X-ray coiling of both atrial and ventricular leads was noted and caused inadvertently by active shoulder-arm physiotherapy. Complete revision of the ICD system was necessary for restoration of the pacemaker function of the ICD. This unique case highlights important steps for early recognition and prevention of Twiddler's syndrome that may occur due to physiotherapy treatment even without abnormal manipulations by the patient.
authors.affiliation: Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Austria.
authors.forename: Christiana
authors.initials: C
authors.lastname: Schernthaner
authors.affiliation: Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Danmayr
authors.affiliation: Department of Cardiac Surgery, Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Krausler
authors.affiliation: Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strohmer
keywords: Implantable cardioverter defibrillator; Lead dysfunction; Physiotherapy; Twiddler Syndrom