Lead failure caused by twiddler's syndrome in subpectorally implanted unipolar single-lead cardioverter-defibrillators

Abstract

Twiddler's syndrome, first described in 1968 by Bayless, Beanlands, and Baird 1 as a rare complication in patients with pacemakers, is characterized by dislodgment of transvenous leads by the twisting of pulse generators in the subcutaneous pocket, resulting in lead malfunction. As might be expected, similar complications could arise in the case of subpectorally placed implantable cardioverterdefibrillators (ICDs). Especially in unipolar defibrillation systems, which use the housing of the ICD itself as the second active defibrillation electrode, device migration could have a fatal influence on the defibrillation field. We report two cases of this rare complication. PATIENT 1. A 66-year-old male patient (body index 24.5 kg/m 2) with severe coronary artery disease and ventricular tachycardia was referred to our clinic. Bypass surgery was