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Year : 2019  |  Volume : 20  |  Issue : 3  |  Page : 118-121

Twiddler's syndrome: An unusual cause of repeated shocks by implantable cardioverter-defibrillator in an asymptomatic patient

1 Department of Internal Medicine, Cleveland Clinic/Akron General Hospital, Akron, OH, USA
2 Department of Cardiovascular Medicine, Cleveland Clinic/Akron General Hospital, Akron, OH, USA
3 Department of Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA

Correspondence Address:
Dr. Ahmad Jabri
Department of Internal Medicine, Akron General Cleveland Clinic, Akron, Ohio
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Source of Support: None, Conflict of Interest: None


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Twiddler's syndrome refers to malfunction of pacemaker or implantable cardioverter-defibrillator (ICD) resulting from deliberate or unintentional twisting of pulse generator in device pocket, resulting in lead dislodgment. We report a case of a 65-year-old woman with multiple ICD shocks and antitachycardia pacing events on device interrogation, while she was unaware of the ICD discharges. Twiddler's syndrome is rare and mostly occurs in obese or elderly because of loose subcutaneous tissue allowing pulse generator to rotate in its pocket. It can be prevented by patient education against hand manipulating the generator. Smaller device pocket or suturing generator to fascia can also prevent future episodes.

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