Twiddler's Syndrome

  • Joshua E. Glick
    Reprint Address: Joshua E. Glick, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
    Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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      A 57-year-old woman with a history of cardiac sarcoidosis, complicated by recent episodes of nonsustained ventricular tachycardia requiring an implantable cardiac defibrillator, presented with 2–3 days of substernal chest wall discomfort and palpitations. Her cardiopulmonary examination was unremarkable, with a regular rhythm and no new murmurs. Initial electrocardiogram (Figure 1) demonstrated a normal sinus rhythm with no ectopic beats, however, supplemental electrical pacing spikes (black arrows) were noted to occur at a regular interval without associated cardiac capture. Chest x-ray study (Figure 2) was notable for a dislodged and retracted single ventricular defibrillator lead located in the superior vena cava (white star) with proximal coiling of the lead about the device body (white arrow). The patient denied manipulating the body of the defibrillator, but did state that she had been frequently adjusting clothing to accommodate her new device pocket.
      Figure 1
      Figure 1Electrocardiogram demonstrating a normal sinus rhythm with supplemental regular electrical pacing spikes without associated cardiac capture.
      Figure 2
      Figure 2Chest x-ray study demonstrating a retracted ventricular lead and coiling of the wiring about the device body.


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