Twiddler Syndrome: A Case Report

Y. Hamine

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

A. Couissi *

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

M. Khalil

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

H. Choukrani

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

I. Nouamou

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

M. G. Bennouna

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

A. Drighil

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

R. Habbal

Cardiology Department, Ibn Rochd Hospital, Casablanca, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Background: Pacemaker (PM) devices are increasingly used to treat cardiac conduction abnomality especially in elderly population. Twiddler syndrome (TS) in PM patients is a condition where patient manipulation of a pacemaker leads to its retraction and dysfunction. TS can be extremely dangerous in patient who depend on PM rhythm and therefore can be fatal.

Case Summary: We present the case of a 52-year-old women who underwent implantation of a of pacemaker for idiopathic third degree auriculo-ventricular block. Forty days after the operation she was admitted to the hospital for recurrent episodes of syncope. Chest radiographs confirmed lead retraction and suggested device manipulation. The patient was immediately transferred to the cath lab to perform a repositioning of the Pacemaker leads.

Discussion: This rare case highlights the life threatening aspect of Twiddler syndrome related to pacemaker. Hence rigorous fixationof the generator and leads is essential, close follow up and meticulous examination of EKG, X ray is primordial especially in the first year following the intervention. Finally patient should be educated not to manipulate their devices with clear explanation of potential consequence of such behavior.

Keywords: Twiddler syndrome, pacemaker, dysfunction


How to Cite

Hamine , Y., A. Couissi, M. Khalil, H. Choukrani, I. Nouamou, M. G. Bennouna, A. Drighil, and R. Habbal. 2023. “Twiddler Syndrome: A Case Report”. Asian Journal of Cardiology Research 6 (1):106-9. https://journalajcr.com/index.php/AJCR/article/view/144.


References

Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler’s syndrome: a new complication of implantable transvenous pacemakers. CMAJ. 1968 Aug 24;99(8): 371–3.

Gomez JO, Doukky R, Pietrasik G, Wigant RR, Mungee S, Baman TS. Prevalence and predictors of Twiddler’s syndrome. Pacing Clin Electrophysiol. 2023 Feb 20;pace.14655.

Mandal S, Pande A, Kahali D. A Rare Case of Very Early Pacemaker Twiddler’s Syndrome. Heart Views Off J Gulf Heart Assoc. 2012 Jul;13(3):114–5.

Tseng AS, Shipman JN, Lee JZ, Mi L, Amin M, Killu AM, et al. Incidence, patterns, and outcomes after transvenous cardiac device lead macrodislodgment: Insights from a population-based study. Heart Rhythm. 2019 Jan;16(1):140–7.

Ghani A, Delnoy PPHM, RamdatMisier AR, Smit JJJ, Adiyaman A, Ottervanger JP, et al. Incidence of lead dislodgement, malfunction and perforation during the first year following device implantation. Neth Heart J. 2014 Jun 1;22(6):286–91.

Vijay SK, Dwivedi SK, Chandra S, Saran RK. Ratchet-traction effect: an underdiagnosed mechanism of pacing lead dislodgement. Indian Heart J. 2014;66(5):555–6.

Fuertes B, Toquero J, Arroyo-Espliguero R, Lozano IF. Pacemaker lead displacement: mechanisms and management. Indian Pacing Electrophysiol J. 2003 Oct 1;3(4):231–8.

Arias MA, Pachón M, Puchol A, Jiménez-López J, Rodríguez-Picón B, Rodríguez-Padial L. Terminology management for implantable cardiac electronic device lead macro-dislodgement. Rev Espanola CardiolEngl Ed. 2012 Jul;65(7):671–3.

Shandling AH, Ellestad MH, Castellanet MJ, Messenger JC. Dacron-Woven Pacemaker Pouch*: Influence on Long-term Pacemaker Mobility. CHEST. 1991 Mar 1;99(3):660–2.

Pande A, Kahali D, Mandal S. A rare case of very early pacemaker Twiddler′s syndrome. Heart Views. 2012; 13(3):114.

Fahraeus T. Early pacemaker twiddler syndrome. Europace. 2003 Jul;5(3):279–81.

DeMarco DC, Xuereb RG. ‘Twiddling’ of the Pacemaker Resulting. 2009;21 (03).