Twiddler Syndrome: A rare complication that we should think a diagnosis
DOI:
https://doi.org/10.33448/rsd-v14i10.49813Keywords:
Twiddler syndrome, Pacemaker, Cardiovascular abnormalities.Abstract
Introduction: Twiddler syndrome is described as an alteration in the positioning of an implantable cardiac device (ICD) resulting from rotation/torsion of the device, which may lead to retraction. Objective: To describe a rare complication related to the ICD and compare the management of two cases. Methodology: This was a retrospective, descriptive, observational, and analytical study of multiple case reports. Results: Both patients were admitted to the hospital one month after implantation of the permanent pacemaker. The electrocardiogram (ECG) showed complete atrioventricular block and device malfunction. Chest X-rays showed device torsion and lead displacement. Patient 1: A 90-year-old man with dyspnea and muscle spasms in the left upper limb related to pectoralis major muscle contraction. He presented stable vital signs. The ECG showed atrial undersensing and loss of capture. Patient 2: Female, 87 years old, with prostration and weakness, low blood pressure, and no other complaints. Conclusion: Twiddler syndrome may be the cause of ICD malfunction in patients after pacemaker implantation. Although rare, with the annual increase in ICD implantations, the number of patients with this syndrome is expected to increase. Chest X-ray and ECG are essential for diagnosis and management of the condition, with possible surgical reoperation for ICD relocation. Clinical cardiologists need to be aware of this syndrome and consider it as a differential diagnosis in patients with ICD, considering it the diagnostic test of choice, low cost, and quick to report, for effective management of the condition.
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Copyright (c) 2025 Maria Fernanda Prevital Garcia, Luiz Guilherme Figueira Honório, Luis Felipe Prevital Garcia, Vitória Teixeira Toniolli, Sabrina Neves Ribeiro, Vanessa Bernardo Nunes Lepre, Valentina Côrtes Vieira
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