Background: Twiddler's syndrome is a rare complication after implantation of cardiac pacemakers or cardioverter-defibrillators that usually occurs within the first year after the procedure. However, it has not yet been described following implantation of baroreflex activation therapy (BAT).
Case Summary: A 61-year-old female patient was referred to the cardiology outpatient clinic due to uncontrolled arterial hypertension despite maximal doses of several established drugs. Therefore, right-sided BAT implantation was successfully performed in February 2017 with good clinical response. Because of sustained neck pain at the site of stimulator, surgical revision was performed in November 2019 including a switch of the lead to the contralateral position. Approximately 1 month later, Twiddler's syndrome was identified on the basis of recurrent pain at the generator site necessitating pocket-revision, however, the lead was only untwisted but not replaced. A few weeks afterwards, unfortunately, lead revision was indispensable due to lead fracture.
Discussion: This case presents the uncommon phenomenon of Twiddler's syndrome after BAT implantation. In addition, the commonly twisted lead should always be replaced as well during surgical pocket-revision in order to ensure proper long-term function.
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http://dx.doi.org/10.1093/ehjcr/ytab126 | DOI Listing |
J Clin Med
December 2024
Hospital Management Department, National Centre for Neurosurgery, 34/1 Turan Avenue, Astana 010000, Kazakhstan.
: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood.
View Article and Find Full Text PDFNeth Heart J
February 2025
Department of Cardiology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.
Cureus
October 2024
Emergency Department, Hospital Las Higueras, Talcahuano, CHL.
Cureus
July 2024
Cardiology, Hospital Clinica Benidorm (HCB), Benidorm, ESP.
Twiddler syndrome is a rare entity in which patient manipulation causes lead dislocation with lead retraction. Reel syndrome, on the other hand, is observed after external manipulation, intentional or unintentional, in which the leads move along their transverse axis and is considered a variant of Twiddler syndrome. We present the clinical case of a 91-year-old female who, after pacemaker implantation, presented with dizziness and chest discomfort following constant manipulation of the pacemaker, resulting in complete retraction of the lead tip into the pouch, which is unusual in the literature to date.
View Article and Find Full Text PDFJ Cardiovasc Imaging
August 2024
Department of Cardiology, AdventHealth New Smyrna, New Smyrna Beach, FL, USA.
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