Serial Case of Twiddler Syndrome
Background: Twiddler syndrome is an infrequent but potentially dangerous complication of device therapy for dysrhythmias. This syndrome results from manipulation of implanted pulse generator by the patient, leading to traction and subsequent lead dislodgement. It can also occur spontaneously. It has...
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| Format: | Article |
| Language: | English |
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Indonesian Heart Association
2017-10-01
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| Series: | Majalah Kardiologi Indonesia |
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| Online Access: | http://ijconline.id/index.php/ijc/article/view/675 |
| _version_ | 1828475600281534464 |
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| author | Pipiet Wulandari Sunu B Raharjo Dicky A Hanafy Lina Haryati Yoga Yuniadi |
| author_facet | Pipiet Wulandari Sunu B Raharjo Dicky A Hanafy Lina Haryati Yoga Yuniadi |
| author_sort | Pipiet Wulandari |
| collection | DOAJ |
| description | Background: Twiddler syndrome is an infrequent but potentially dangerous complication of device therapy for dysrhythmias. This syndrome results from manipulation of implanted pulse generator by the patient, leading to traction and subsequent lead dislodgement. It can also occur spontaneously. It has been increasingly reported with pacemaker or implantable cardioverter-defibrillators (ICDs). In this reports, we describe two patients with Twiddler syndrome with substantial retraction of their lead who denied any manipulation of their device.
Case Illustration: The first patient was a 56 year-old man with single-chamber ICD due to dilated cardiomyopathy (DCM) with congestive heart failure and severe systolic left ventricular dysfunction (ejection fraction 18%). The dislodged lead causing rhythmical twitching of left pectoral muscles and abdominal pulsations. The second patient was a 69 year-old man with dual-chamber pacemaker due to total atrioventricular block with normal systolic left ventricular function (ejection fraction 70%). It manifested as dyspnea on effort, and he also underwent pacemaker implantation. They underwent primary devices implantation at April 2016 and reposition of generators and its leads in December 2016. The first and second patients denied of manipulating the generator of ICD or pacemaker and rotated their left arm and right arm, respectively, after implantation.
Summary: Other unconscious arm abduction during sleep or increased muscular activity of the shoulder and arm might have led to repetitive motions within the pocket and dislodge the device. Adequate individualized patient and family education and regular evaluation every 6 month of the leads position with fluoroscopy or chest X-ray is advisable. |
| first_indexed | 2024-12-11T06:15:58Z |
| format | Article |
| id | doaj.art-e73606e4145a450d9f4d109a9fe673a9 |
| institution | Directory Open Access Journal |
| issn | 0126-3773 2620-4762 |
| language | English |
| last_indexed | 2024-12-11T06:15:58Z |
| publishDate | 2017-10-01 |
| publisher | Indonesian Heart Association |
| record_format | Article |
| series | Majalah Kardiologi Indonesia |
| spelling | doaj.art-e73606e4145a450d9f4d109a9fe673a92022-12-22T01:17:58ZengIndonesian Heart AssociationMajalah Kardiologi Indonesia0126-37732620-47622017-10-0138110.30701/ijc.v38i1.675Serial Case of Twiddler SyndromePipiet Wulandari0Sunu B Raharjo1Dicky A Hanafy2Lina Haryati3Yoga Yuniadi4Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sebelas MaretDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia-Harapan Kita National Cardiovascular CenterDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia-Harapan Kita National Cardiovascular CenterDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas BrawijayaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia-Harapan Kita National Cardiovascular CenterBackground: Twiddler syndrome is an infrequent but potentially dangerous complication of device therapy for dysrhythmias. This syndrome results from manipulation of implanted pulse generator by the patient, leading to traction and subsequent lead dislodgement. It can also occur spontaneously. It has been increasingly reported with pacemaker or implantable cardioverter-defibrillators (ICDs). In this reports, we describe two patients with Twiddler syndrome with substantial retraction of their lead who denied any manipulation of their device. Case Illustration: The first patient was a 56 year-old man with single-chamber ICD due to dilated cardiomyopathy (DCM) with congestive heart failure and severe systolic left ventricular dysfunction (ejection fraction 18%). The dislodged lead causing rhythmical twitching of left pectoral muscles and abdominal pulsations. The second patient was a 69 year-old man with dual-chamber pacemaker due to total atrioventricular block with normal systolic left ventricular function (ejection fraction 70%). It manifested as dyspnea on effort, and he also underwent pacemaker implantation. They underwent primary devices implantation at April 2016 and reposition of generators and its leads in December 2016. The first and second patients denied of manipulating the generator of ICD or pacemaker and rotated their left arm and right arm, respectively, after implantation. Summary: Other unconscious arm abduction during sleep or increased muscular activity of the shoulder and arm might have led to repetitive motions within the pocket and dislodge the device. Adequate individualized patient and family education and regular evaluation every 6 month of the leads position with fluoroscopy or chest X-ray is advisable.http://ijconline.id/index.php/ijc/article/view/675Twiddler syndromeimplanted cardioverter-defibrillator (ICD)dual chamber pacemaker |
| spellingShingle | Pipiet Wulandari Sunu B Raharjo Dicky A Hanafy Lina Haryati Yoga Yuniadi Serial Case of Twiddler Syndrome Majalah Kardiologi Indonesia Twiddler syndrome implanted cardioverter-defibrillator (ICD) dual chamber pacemaker |
| title | Serial Case of Twiddler Syndrome |
| title_full | Serial Case of Twiddler Syndrome |
| title_fullStr | Serial Case of Twiddler Syndrome |
| title_full_unstemmed | Serial Case of Twiddler Syndrome |
| title_short | Serial Case of Twiddler Syndrome |
| title_sort | serial case of twiddler syndrome |
| topic | Twiddler syndrome implanted cardioverter-defibrillator (ICD) dual chamber pacemaker |
| url | http://ijconline.id/index.php/ijc/article/view/675 |
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