Semaglutide-induced rapid weight loss of 25 kg in a patient with an ICD led to Twiddler syndrome and right ventricular lead dysfunction, requiring extraction and reimplantation.
Case Report (n=1)
Does semaglutide-induced weight loss increase the risk of Twiddler syndrome in patients with cardiac implantable electronic devices?
Substantial weight loss from GLP-1 receptor agonists like semaglutide can increase generator mobility in the subcutaneous pocket, potentially leading to Twiddler syndrome in patients with cardiac implantable electronic devices.
Abstract 52-year-old woman with cardiac sarcoidosis and a dual-chamber implantable cardioverter defibrillator (ICD) was treated with semaglutide for refractory obesity (body mass index (BMI) of 40.1 (kg/m2)). After rapid weight loss of 25 kg, she developed painful device mobility and right ventricular lead dysfunction. Chest x-ray revealed lead entanglement consistent with Twiddler syndrome, which is a mechanical complication in which a pacemaker or ICD rotates within its pocket, causing the leads to twist or dislodge and resulting in device malfunction. Lead extraction was complicated by cardiac tamponade. After recovery, she underwent successful reimplantation of a single-chamber ICD. Patients with cardiac implantable electronic devices who are treated with glucacon-like-peptide-1 receptor agonists may have an increased risk of Twiddler syndrome, as substantial weight loss can increase generator mobility in the subcutaneous pocket. Clinicians should recognize this rare but potentially life-threatening complication.
Seiler et al. (Fri,) conducted a case report in Cardiac sarcoidosis and refractory obesity with an ICD (n=1). Semaglutide was evaluated on Twiddler syndrome and right ventricular lead dysfunction. Semaglutide-induced rapid weight loss of 25 kg in a patient with an ICD led to Twiddler syndrome and right ventricular lead dysfunction, requiring extraction and reimplantation.