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Twiddler’s syndrome in a biventricular implantable cardioverter-defibrillator
  1. E J Shepherd,
  2. J M McComb
  1. theshepherdfamilytiscali.co.uk

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This 76 year old man had a biventricular implantable cardioverter-defibrillator (ICD) implanted on 14 March 2003 for heart failure and ventricular tachycardia (VT) caused by ischaemic heart disease. At first follow up his ECG suggested right ventricular pacing only. Chest x ray confirmed that the ICD had been rotated clockwise through almost 360°. The left ventricle (LV) lead was displaced with loss of LV pacing, as was the active fixation atrial lead. The patient admitted to rubbing the pacemaker can with a clockwise rotation while washing, which we presume resulted in the system displacement. The leads were repositioned and the device re-implanted. He has since remained well with biventricular pacing.


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