Twiddler's syndrome detected by patient's complaint of implantable cardioverter-defibrillator rotation in the subcutaneous pocket

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  • Konishi Hirokazu
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Tokano Takashi
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Nakazato Yuji
    Department of Cardiology, Juntendo University Urayasu Hospital
  • Komatsu Sayaka
    Department of Cardiology, Juntendo University School of Medicine
  • Suwa Satoru
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Komatsu Kaoru
    Department of Cardiology, Juntendo University School of Medicine
  • Hayashi Hidemori
    Department of Cardiology, Juntendo University School of Medicine
  • Sekita Gaku
    Department of Cardiology, Juntendo University School of Medicine
  • Sumiyoshi Masataka
    Department of Cardiology, Juntendo University Nerima Hospital
  • Bito Fumiyasu
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Kizu Kyoko
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Daida Hiroyuki
    Department of Cardiology, Juntendo University School of Medicine

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  • Twiddler's syndrome detected by patient's complaint of implantable cardioverter‐defibrillator rotation in the subcutaneous pocket

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Description

Twiddler's syndrome presents as a rare implantable-cardioverter defibrillator (ICD) malfunction that is potentially fatal. The following case is that of a 79-year-old woman, who was implanted with an ICD and experienced Twiddler's syndrome. Five months after the implantation, the patient complained that the generator sometimes rotated in the subcutaneous pocket. Fluoroscopy showed that the generator had rotated and the leads were twisted, which is compatible with Twiddler's syndrome. Although all the leads were functioning normally, a procedure to repair the twisted leads was performed. Twiddler's syndrome is usually detected due to a serious device malfunction; however, this case study suggests that it can be detected prior to ICD malfunction by the patient's complaint.

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