Roberta Montisci, Cinzia Soro, Roberta Demelas, Elena Agus, Alessio Follesa, Gesualdo Siragusa, Vincenzo Nissardi

A case series of the Twiddler Syndrome

  • Cardiology and Cardiovascular Medicine
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Abstract Background Twiddler Syndrome (TS) is a complication of cardiac implantable electronic devices (CIED) implantation, caused by the deliberate or unconscious manipulation of the device by the patient himself, which results in dislocation of the leads by retraction towards the subcutaneous pocket. Case Summary This report describes two clinical cases that occurred in our center, for which two different solutions were successfully implemented. In the first case a complete removal of the stimulation system was performed and a leadless PM (Medtronic Micra VR) was implanted. In the second case the patient underwent a revision procedure. The pacemaker was disconnected, and the electrodes were debrided, a sub-muscular pocket for the PM was created and at the end of the procedure the pacemaker was anchored to the pectoralis major. Discussion TS is a rare and serious complication of CIED implantation, leading to device malfunctioning and higher risk of infection of the pocket due to multiple re-interventions. In these two cases, different surgical solutions were performed, both resulting to be effective to solve the effects of TS.

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