Aggressive Pacemaker Twiddler's Syndrome

Lal, Raj B.; Avery, Robert

doi:10.1378/chest.97.3.756

Cited by 18 publications

(4 citation statements)

References 5 publications

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“…Plusieurs variétés de ce syndrome ont été décrites avec la manipulation d'autres dispositifs comme les défibrillateurs automatiques implantables [7] et les chambres implantables [8]. Afin de prévenir ce syndrome, il est recommandé de fixer le dispositif implanté au plan musculaire [9], la réduction de la taille de la loge et dans certains cas par la confection d'une poche en dacron autour du dispositif implanté [10]. L'utilisation d'une sonde à fixation active est recommandée par certaines équipes [11].…”

Section: Discussionunclassified

Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler

Amor¹,

Sofiane²,

Zoghlami³

et al. 2019

Pan Afr Med J

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Le syndrome de Twiddler, une complication rare mais potentiellement létale de l’implantation de stimulateur cardiaque. Il est généralement diagnostiqué dans la première année de l'implantation. Il est caractérisé par un dysfonctionnement de l'appareil en raison de délogement de la sonde de pacemaker suite à l’auto manipulation du patient. Le syndrome de Twiddler a été décrit en 1968 comme une complication de l'implantation du stimulateur. Il a également été rapporté avec les défibrillateurs implantables et les resynchroniseurs cardiaques. Il s'agit du cas d'une vieille dame admise pour syndrome de Twiddler, ce qui a entraîné un dysfonctionnement de stimulateur cardiaque secondaire au déplacement de la sonde du pacemaker. Elle a bénéficié d’un repositionnement de la sonde ainsi que des conseils appropriés.

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Section: Discussionunclassified

Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler

Amor¹,

Sofiane²,

Zoghlami³

et al. 2019

Pan Afr Med J

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“… Patient felt spontaneous movement of IPG Leads and IPG anchored the fascia with silk sutures Castillo et al 2006 [ 10 ] USA Pacemaker 76-year-old male Dementia Manipulation of the device Conversion of pacemaker mode and restrictive recommendations to prevent manipulation De Buitleir et al 1996 [ 12 ] USA ICD 54-year-old female Obesity Denies manipulation but on waking in the morning notices the ICD sitting on the side Lead revision Femenia et al 2010 [ 13 ] Argentina Pacemaker 74-year-old female Moving arms energetically IPG anchored to pocket Geissinger et al 2007 [ 16 ] USA DBS 65-year-old female Patient felt IPG shifted IPG placed into a polyester pouch and secure to surrounding tissue Gelabert-Gonzalez et al 2010 [ 17 ] Spain DBS 68-year-old female, Parkinson’s disease 65-year-old female Patient admitted twisting the generator. Replacement of the electrode and extension wires Harel et al 2008 [ 20 ] Israel Pacemaker 69-year-old female Not stated Re-implantation of electrode Israel et al 2008 [ 21 ] Israel DBS – bilateral thalamic surgery 65-year-old female No psychiatric history Patient complained of an itching sensation over incision and was advised to gently massage the incision Leads revision and IPG sutured to periosteum and fascia with silk sutures, subcutaneous pocket contracted by sutures Jaafari et al 2009 [ 22 ] France ICD 47-year-old male Obsessional personality traits Since the implantation the patient had increased anxiety and described fears of having chest pain and of dying as well as receiving shocks which led to compulsive checking behaviour of ICD Patient underwent cognitive behavioural therapy and antidepressants Lal et al 1990 [ …”

Section: Discussionmentioning

confidence: 99%

“…Reported measures to reduce the incidence of IPG displacement and Twiddler’s syndrome include suture sleeves [ 27 , 30 ]. Others have used prolene mesh, non-absorbable sutures, anchoring the IPG to the fascia, placing the IPG in a submuscular plane and limiting the pocket size to prevent further occurrences of Twiddler’s syndrome [ 3 , 17 , 21 , 31 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Twiddler’s syndrome is rare clinical condition. It is commonly been reported in cardiac pacemakers and implantable cardioverter defribrillators [ 5 , 7 , 12 , 13 , 19 , 24 , 27 , 28 , 30 , 32 , 39 ]. In neurosurgical practice, Twiddler’s syndrome has been reported in deep brain stimulation but never in spinal cord stimulation (SCS) [ 3 , 9 , 16 , 17 , 21 , 31 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

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Twiddler’s syndrome in spinal cord stimulation

et al. 2015

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BackgroundThe aims are to present a case series of Twiddler’s syndrome in spinal cord stimulators with analysis of the possible mechanism of this syndrome and discuss how this phenomenon can be prevented.MethodData were collected retrospectively between 2007 and 2013 for all patients presenting with failure of spinal cord stimulators. The diagnostic criterion for Twiddler’s syndrome is radiological evidence of twisting of wires in the presence of failure of spinal cord stimulation.ResultsOur unit implants on average 110 spinal cord stimulators a year. Over the 5-year study period, all consecutive cases of spinal cord stimulation failure were studied. Three patients with Twiddler’s syndrome were identified. Presentation ranged from 4 to 228 weeks after implantation. Imaging revealed repeated rotations and twisting of the wires of the spinal cord stimulators leading to hardware failure.ConclusionsTo the best of our knowledge this is the first reported series of Twiddler’s syndrome with implantable pulse generators (IPGs) for spinal cord stimulation. Hardware failure is not uncommon in spinal cord stimulation. Awareness and identification of Twiddler’s syndrome may help prevent its occurrence and further revisions. This may be achieved by implanting the IPG in the lumbar region subcutaneously above the belt line. Psychological intervention may have a preventative role for those who are deemed at high risk of Twiddler’s syndrome from initial psychological screening.

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The effect on upper extremity functions of cardiac electronic device placement on the dominant hand side

Şimşek

Güvendi

Şimşek

et al. 2019

Journal of Arrhythmia

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Background Although cardiac implantable electronic device ( CIED ) implantation is considered to be minor surgery, almost 60% of the patients suffer from shoulder‐related problems a short time after the procedure. The purpose of this study was to determine the possible effects of the preference of the dominant side for CIED implantation on the ipsilateral superior extremity functions. Methods The study included a total of 107 patients who had been living with a CIED for >6 months. Patients were separated into two groups according to the dominant hand and side of the CIED . The ipsilateral dominant‐hand group comprised those with a CIED on the same side as the dominant hand and the contralateral dominant‐hand group included patients with the CIED placed on the contralateral side to the dominant hand. Visual analogue scale ( VAS ) pain score, quick disability of the arm shoulder and hand questionnaire (Quick DASH ) and maximum isometric grip strength tests were used to evaluate the upper extremity disabilities. Results No significant difference was determined between the groups in respect of VAS pain scores ( P = 0.10), Quick DASH scores ( P = 0.21), and limitations of the shoulder joint range of motion ( P = 0.192). The maximum isometric grip strength was significantly different in the right hands between two groups (34 [16‐95]‐40 [24‐85]) ( P = 0.02). Conclusion The present study shows that the joint range of motion limitation, pain, and disability of the upper extremity were no different in the affected arm compared to the healthy contralateral side with respect to the placement of the CIED on the dominant or non‐dominant side.

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Aggressive Pacemaker Twiddler's Syndrome

Cited by 18 publications

References 5 publications

Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler

Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler

Twiddler’s syndrome in spinal cord stimulation

The effect on upper extremity functions of cardiac electronic device placement on the dominant hand side

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