Twiddler's syndrome in a patient with CRT-D device - A case report

Area of Science:

• Cardiology
• Medical Devices
• Patient Safety

Background:

• Pacemaker lead dislodgement is a known complication.
• Cardiac re-synchronization therapy defibrillators (CRT-D) are complex devices.
• Twiddler's syndrome is an uncommon cause of lead displacement.

Observation:

• A 61-year-old female patient reported chest uneasiness and vibratory sensations.
• The patient had a CRT-D implanted 10 months prior.
• Fluoroscopy showed pulse generator rotation and dislodgement of all three leads.

Findings:

• The clinical presentation and fluoroscopic findings were consistent with Twiddler's syndrome.
• The syndrome involves the patient manipulating the implanted pulse generator, leading to lead issues.

Implications:

• Awareness of Twiddler's syndrome is crucial for diagnosing lead dislodgement.
• Patient education regarding device manipulation may help prevent this complication.
• This case underscores the importance of considering behavioral factors in device-related issues.