Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 4, Number 2, April 2013, pages 85-88

Physiotherapy as a Rare Cause of Twiddler’s Syndrome in a Patient With an Implanted Cardioverter Defibrillator

Figures

Figure 1.
Figure 1. (A) The printout shows loss of capture at 3.0 V @ 0.5 ms during ventricular threshold testing suggestive of subacute increase of pacing threshold in ischemic cardiomyopathy. (B) Strip shows no capture of atrial pacing at maximum output of 7.0 V together with clearly reduced amplitude of the intrinsic atrial signal due to farfield sensing of the retracted electrode. (C) The impedance values of the atrial, ventricular and shock lead remained within the normal range despite the threshold problems.
Figure 2.
Figure 2. (A) The chest X-ray was indicative of Twiddler’s syndrome demonstrating retraction of the atrial lead and excessive coiling near the ICD header (see arrows). (B) Image taken during surgical revision of the ICD system showing coiled leads in situ still connected to the ICD.