Twiddler's Syndrome

Abstract

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.