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A 65-year-old woman with a cardiac resynchronisation therapy-defibrillator underwent routine device interrogation, revealing abnormalities in the atrial lead (reduced amplitude and occasional detection failure) and the right ventricular lead (increased pacing threshold) 13 months post-implantation. This prompted a chest X‑ray due to suspected lead dislodgement (Fig. 1b).
The X‑ray revealed twisted and macro-dislodged leads, along with pulse generator rotation, indicative of both Twiddler and Reel syndromes. These syndromes result from specific mechanisms of macro-dislodgement caused by movements of the generator or leads ([1]; Fig. 1c).
Potential risk factors are debated and include a psychiatric history, obesity, advanced age, an oversized pocket, manual manipulation, and the absence of generator fixation [2]. In our patient, the last two factors were present. Suturing the generator may be the most effective preventive strategy [3], although it is considered optional [4].
Even in the presence of risk factors, there are no specific guidelines recommending increased follow-up, reimplantation procedures, or routine radiography. However, routine imaging can be useful in identifying dislodgement [5] and is therefore advisable in conjunction with routine electrical testing. Lead revision is definitively recommended in cases of lead dysfunction [4].
Conflict of interest
P. Rossignon, R. Tajildin and E. Famdie declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
