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Twiddler’s syndrome – an unusual cause of oversensing leading to inadequate implantable-cardioverter discharges


Authors: K. Židová;  M. Novák;  J. Lipoldová
Published in: Kardiol Rev Int Med 2012, 14(4): 267-271
Category: Case report - competitive

Overview

We present a case of a 74-year-old woman with the history of chronic co­ronary artery disease and permanent atrial fibrillation that underwent implatable cardioverter-defibrillator implantation for a secondary prevention of sudden cardiac death in July 2012. One month after the implantation the patient was referred to our department because of the 2 implantable cardioverter-defibrillator shocks. Upon interrogation 18 ventricular arrhythmia episodes were revealed – 4 in ventricular fibrillation zone, 4 in ventricular tachycardia zone and 10 episodes of nonsustained ventricular tachycardia, managed by 2 implantable cardioverter-defibrillator shocks and 5 antitachycardia pacings in total. According to the intracardial electrograms of the episodes, all the therapies were inappropriate due to atrial fibrillation waves oversensing. The cause of the oversensing was a defibrillator lead dislodgment into the right atrium which was confirmed by a chest X-ray. This case demonstrates an unusual case of oversensing leading to inappropriate implantable cardioverter-defibrillator discharges caused by the repetitive spinning of the pacemaker’s pulse generator in the pocket (Twiddler’s syndrome).

Keywords:
implantable cardioverter-defibrillator – lead dislodgement – inadequate ICD therapy


Sources

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Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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