A New Form of Twiddler’s Syndrome?
A70-year-old man with a history of rheumatic mitral stenosis and valve replacement was admitted to our hospital because of near-syncope. A 12-lead ECG demonstrated atrial fibrillation with a ventricular response of 35 bpm. Evaluation with a 24-hour Holter monitor showed many episodes of prolonged pauses of >3 seconds. A ventricular-demand pacemaker was implanted to prevent loss of consciousness. A transvenous pacemaker electrode (Biotronik SX 53-BP) was inserted via the right subclavian vein and connected to the pulse generator (Biotronik Dromos SR) implanted subcutaneously in the right subclavian area (Figures 1⇓ and 2⇓). The patient did well until 1 month after implantation, when he presented again with near-syncope. Evidence of pacemaker activity on the ECG was absent even after the application of a magnet on the pulse generator. A chest radiograph showed the lead coiling around the pulse generator (Figure 3⇓). A new surgical procedure was urgently performed. During reimplantation, the pacemaker lead was easily uncoiled, repositioned, and carefully fixed to the fascia. The electrode was connected to the same pulse generator. It was not necessary to remove any device. During the follow-up period of 20 months, there was no evidence of new complications.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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