Key Teaching Points
- Twiddler’s syndrome refers to the deliberate or unintentional twisting
of the pulse generator in a device pocket resulting in lead
displacement.
- It is of paramount importance to diagnose and intervene early to avoid
morbidity and mortality in patients with both transvenous and
subcutaneous ICDs.
- Certain surgical techniques can reduce the risk of twiddler’s syndrome
in TV-ICD placement, such as anchoring sutures to pectoralis fascia,
non-absorbable antimicrobial pouches, and woven Dacron pouches. These
same strategies may be effective with S-ICDs.