Late twiddler syndrome in a patient with a submuscular implantable cardioverter defibrillator

Description 

A 20-year-old woman with long-QT syndrome received a submuscular Fortify DR-St Jude implantable cardioverter defibrillator (ICD) after an episode of cardiac arrest. She felt an ICD pocket vibration 23 months later due to a high lead impedance and loss of capture. Chest radiography (figure 1A,B) showed both lead displacement and winding of the leads beside the ICD generator. These findings were confirmed during surgery (figure 1C). The patient strongly denied any box manipulation. She was discharged after new leads implantation with no complications.

Figure 1

(A) and (B) Chest radiography showing both lead displacement and winding of the leads close implantable cardioverter defibrillator generator. (C) Intraoperative finding of lead twisting.

There is a report of three patients with ICD with submuscular devices in whom a twiddler's syndrome occurred despite any risk factors were be seen. It is discussed that the cause...

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