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Article

Twiddler Syndrome without Twiddling: A Case of Lead Dislodgment and Inappropriate Shocks

1Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA

2Barnard College, New York City, NY, USA

3Department of Internal Medicine, Ascension St Agnes Hospital, Baltimore, USA

4Department of Electrophysiology, Richmond University Medical Center, Staten Island, NY, USA


American Journal of Cardiovascular Disease Research. 2025, Vol. 10 No. 1, 15-17
DOI: 10.12691/ajcdr-10-1-3
Copyright © 2025 Science and Education Publishing

Cite this paper:
Resha Reya Ganthan, Rayna Isber, Joud Fahed, Nidal Isber. Twiddler Syndrome without Twiddling: A Case of Lead Dislodgment and Inappropriate Shocks. American Journal of Cardiovascular Disease Research. 2025; 10(1):15-17. doi: 10.12691/ajcdr-10-1-3.

Correspondence to: Resha  Reya Ganthan, Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA. Email: reshareya15@gmail.com

Abstract

Twiddler syndrome is a rare complication of cardiac implantable electronic devices (CIEDs) typically caused by patient manipulation of the generator, leading to lead dislodgement. We present a unique case of a patient with a biventricular implantable cardioverter-defibrillator (ICD) who developed atrial and ventricular lead dislodgement without evidence of device manipulation. The patient experienced six consecutive inappropriate ICD shocks due to oversensing and double counting of atrial and ventricular signals by the right ventricular (RV) lead. This case highlights a variant of Twiddler syndrome occurring in the absence of twiddling, underscoring the importance of vigilance for device malfunction even without patient-induced factors.

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