Image in Cardiology
Twiddler's syndrome, a rare cause of pacemaker malfunction
Síndrome de Twiddler, uma causa rara de disfunção de sistema de pacing
Gustavo Lima da Silva
, Miguel Nobre Menezes, Ana Bernardes, Paula Lopes, João de Sousa, Pedro Marques
Corresponding author
Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Síndrome de Twiddler, uma causa rara de disfunção de sistema de <span class="elsevierStyleItalic">pacing</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 725 "Ancho" => 1765 "Tamanyo" => 177759 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray showing coiling of the pacing leads around the pulse generator; (B) removal of the pacing system with the leads coiled around the pulse generator; (C) in-situ anti-manipulation fixation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 68-year-old female with a previous history of breast cancer treated by left mastectomy, chest radiotherapy and systemic chemotherapy was admitted to our cardiology department for syncope due to intermittent complete heart block and underwent right-sided dual-chamber pacemaker implantation using active fixation leads.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Three months after the procedure the patient was asymptomatic, but a pacemaker malfunction was detected with loss of pacing and sensing of both atrial and ventricular leads. A chest X-ray was performed which revealed coiling of the pacing leads around the pulse generator (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). A diagnosis of twiddler's syndrome was made. The patient underwent surgical revision of the pacemaker pocket and the pacing system was removed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). A new pacemaker was implanted and anti-manipulation fixation was performed to prevent recurrence (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 725 "Ancho" => 1765 "Tamanyo" => 177759 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray showing coiling of the pacing leads around the pulse generator; (B) removal of the pacing system with the leads coiled around the pulse generator; (C) in-situ anti-manipulation fixation.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000001/v2_201703220342/S2174204916000076/v2_201703220342/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000001/v2_201703220342/S2174204916000076/v2_201703220342/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000076?idApp=UINPBA00004E" ]
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