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

Resha Reya Ganthan^1, , Rayna Isber², Joud Fahed³ and Nidal Isber⁴

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

Cite this paper:
Resha Reya Ganthan, Rayna Isber, Joud Fahed and 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

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.

Keywords:
Twiddler syndrome Implantable cardioverter-defibrillator (ICD) Lead dislodgement Device malfunction Inappropriate shocks Cardiac implantable electronic device (CIED) Lead migration

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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