9/25/2023 0 Comments Pacing failure to captureElderly age group, pediatric age, obesity, female gender, psychiatric illness, cognitive dysfunction and the large pocket size relative to the device size are the risk factors for this condition. It is dangerous in patients with a defibrillator, because of inappropriate shocks due to the loss of adequate sensing and capture and possible false treatment of malignant ventricular arrhythmias. It is of particular importance in pacemaker-dependent patients. The earliest reported case was at 17 hours after implantation. This complication usually occurs in the first year of implantation, it may occur after one year. The reported incidence of Twiddler's syndrome is around 0.07-7%. Various case reports have been published in the past describing this syndrome. Twiddler syndrome was originally described with pacemakers the condition has also been reported with implantable cardioverter-defibrillators. Postoperative hospital stay was uneventful, and the patient was asymptomatic at subsequent follow-ups.įigure 4: The condition of the lead after uncoiling. The pulse-generator was fixed on the pectoral muscle with non-absorbable suture. The parameters were checked, R wave, the threshold, and lead impedance were 14 mV, 0.5 V, and 700 ohms, respectively. A new active fixation screwing ventricular lead was inserted at the right ventricular apex. The condition of the lead just after opening the pocket and after uncoiling is shown (Figure 3 and Figure 4). Under all aseptic precautions, the pacemaker pocket was immediately reopened. A diagnosis of pacemaker Twiddler's syndrome was made. Fluoroscopy showed twisted ventricular lead and its retraction into the right atrium (Figure 1 and Figure 2). Temporary pacemaker lead was inserted through the right femoral route and connected to the pulse generator. A pulsation in her abdomen due to diaphragmatic stimulation was observed. Electrocardiogram showed atrial fibrillation with a ventricular rate of 36/minute. The patient was again admitted with one episode of syncope and twitching in the right upper quadrant of the abdomen. The pacemaker implantation procedure was uneventful. Postoperative fluoroscopic images confirmed the satisfactory positioning of ventricular lead. Measured ventricular lead R wave, the threshold, and lead impedance were 12 mV, 0.4 V, and 650 ohms, respectively. The pulse generator was also fixed to the underlying pectoral muscle with non-absorbable stay suture. A bipolar active fixation, screwing lead was placed at the right ventricular apex. JUDE -VVI) was implanted in the right infra-clavicular area. A Single chamber permanent pacemaker (ST. Echocardiography showed mild dilatation of the left atrium, mild concentric left ventricular hypertrophy with an ejection fraction of 60%. All the reversible causes of the condition were ruled out. Temporary pacemaker lead was inserted through the right femoral venous route. Electrocardiogram showed atrial fibrillation with a ventricular rate of 34/minute. On admission pulse was 34/minute and blood pressure was 160/90 mmHg. She is also a case of the chronic obstructive pulmonary disease. She is a known diabetic and hypertensive. We report a case of 84-year-old female who presented with syncope and twitching sensation in the right upper quadrant of the abdomen, 4 weeks after the implantation of a permanent pacemaker.Ĩ4-year-old female was admitted with recurrent syncope. The coiling of the lead results in lead retraction, lead damage and cause lead fracture or insulation leakage. This results in coiling of the pacemaker lead due to the rotation of pacemaker generator on its long axis. It occurs because of unintentional or deliberate manipulation of the pulse generator within its skin pocket by the patient. in 1968, when a patient manipulated and rotated the pulse generator in the pocket resulting in lead dislodgement, diaphragmatic stimulation, and loss of capture. Twiddler's syndrome was first described by Bayliss, et al. Twiddler's syndrome, Lead dislodgement, Pacemaker malfunction We report a case of 84-year-old female who was readmitted after 4 weeks of implantation of permanent pacemaker with syncope and diaphragmatic stimulation. The treatment involves readmission, repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. It usually occurs in the first year following pacemaker implantation. In a pacemaker dependent patient, it can be a lethal complication. It results in lead dislodgment, diaphragmatic stimulation, and loss of capture. It is caused by conscious or unconscious manipulation at the implantation site by the patient with the result of device malfunction. Twiddler's syndrome is a rare complication after pacemaker implantation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |