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  • Title: Subcutaneous Implantable Cardioverter Defibrillator Lead Failure due to Twiddler Syndrome.
    Author: Kooiman KM, Brouwer TF, Van Halm VP, Knops RE.
    Journal: Pacing Clin Electrophysiol; 2015 Nov; 38(11):1369-71. PubMed ID: 26306701.
    Abstract:
    We present a case of Twiddler syndrome in a patient with a subcutaneous implantable cardioverter defibrillator (S-ICD). The patient presented herself to the outpatient clinic with pain in the left chest. Chest x-ray confirmed Twiddler syndrome and ICD read-out revealed lead failure resulting in absent heart rhythm sensing in one vector. The lead and pulse generator were extracted and a new S-ICD system was reimplanted submuscular underneath the serratus anterior muscle to prevent reoccurrence. Lead investigation revealed an insulation defect caused by excessive mechanical stress.
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