A case series of the twiddler syndrome.

Case series Leadless pacemaker Submuscular pacemaker implant Twiddler syndrome

Journal

European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741

Informations de publication

Date de publication:
Jan 2024
Historique:
received: 01 02 2023
revised: 27 09 2023
accepted: 03 01 2024
medline: 19 1 2024
pubmed: 19 1 2024
entrez: 19 1 2024
Statut: epublish

Résumé

Twiddler syndrome (TS) is a complication of cardiac implantable electronic device (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. This report describes two clinical cases that occurred in our centre, for which two different solutions were successfully implemented. In the first case, a complete removal of the stimulation system was performed, and a leadless pacemaker (PM; Medtronic Micra VR) was implanted. In the second case, the patient underwent a revision procedure. The PM was disconnected, and the electrodes were debrided, a submuscular pocket for the PM was created, and at the end of the procedure, the PM was anchored to the pectoralis major. Twiddler syndrome is a not so 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.

Sections du résumé

Background UNASSIGNED
Twiddler syndrome (TS) is a complication of cardiac implantable electronic device (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 UNASSIGNED
This report describes two clinical cases that occurred in our centre, for which two different solutions were successfully implemented. In the first case, a complete removal of the stimulation system was performed, and a leadless pacemaker (PM; Medtronic Micra VR) was implanted. In the second case, the patient underwent a revision procedure. The PM was disconnected, and the electrodes were debrided, a submuscular pocket for the PM was created, and at the end of the procedure, the PM was anchored to the pectoralis major.
Discussion UNASSIGNED
Twiddler syndrome is a not so 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.

Identifiants

DOI: 10.1093/ehjcr/ytae004 PMID: 38239312 PMC: PMC10794872
pubmed: 38239312
doi: 10.1093/ehjcr/ytae004
pii: ytae004
pmc: PMC10794872
doi:

Types de publication

Case Reports

Langues

eng

Pagination

ytae004

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest: None declared.

Auteurs

Roberta Montisci (R)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.
ORCID: 0000-0002-7218-6751

Cinzia Soro (C)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.
Cardiologia-UTIC, Struttura Semplice di Cardiostimolazione, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Roberta Demelas (R)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Elena Agus (E)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Alessio Follesa (A)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Gesualdo Siragusa (G)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.
Cardiologia-UTIC, Struttura Semplice di Cardiostimolazione, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Vincenzo Nissardi (V)

Cardiologia-UTIC, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.
Cardiologia-UTIC, Struttura Semplice di Cardiostimolazione, Policlinico 'D. Casula', Azienda Ospedaliero-Universitaria-Cagliari, SS. 554, Km 4,5, Monserrato, Cagliari 09042, Italy.

Classifications MeSH