Twiddler's syndrome

Case: 62-year-old male with a history of congestive heart failure (CHF) is admitted to ICU with syncope, arrhythmia, and exacerbation of CHF. EP-cardiologist diagnosed patient with twiddler's syndrome, which is the twisting of the cardiac implantable electronic device (CIED) pulse generator within its pocket. Patients with twiddler's syndrome are more likely to have? (select one) 

A) bradyarrhythmia 
B) tachyarrhythmia


Answer: A

Twiddler's syndrome as described above is the twisting of the cardiac implantable electronic device (CIED) pulse generator within its pocket. It causes dislodgement of the lead and malfunction of the device. This leads to either lead impedance or increase in the bradycardic pacing threshold. Said that, with malfunction device, CIED may not respond in case of ventricular arrhythmia. Precautions at the initial insertion may prevent this complication.

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Reference:

Chaara J, Sunthorn H. Twiddler syndrome. J Cardiovasc Electrophysiol 2014; 25:659.