The TYRX absorbable antibacterial envelope may paradoxically promote Twiddler's syndrome through the formation of a yellow viscous fluid in the device pocket.
TYRX-associated tissue changes in these cases warrant caution in CIED patients; leaves open questions on envelope safety beyond prior trials.
Key Teaching Points•Cardiac implantable electronic device (CIED) infection and Twiddler’s syndrome are associated with adverse morbidity and mortality outcomes, with key risk factors including patients having undergone multiple/complex procedures.•The use of TYRX envelope has been shown in prior studies to reduce the risk of CIED infections as well as Twiddler’s syndrome, although not in the 2 cases we have described.•In our cases, the use of TYRX has been associated with the formation of yellow viscous fluid, which in turn could promote hypermobility of the device and leads in the pocket and cause Twiddler’s syndrome. •Cardiac implantable electronic device (CIED) infection and Twiddler’s syndrome are associated with adverse morbidity and mortality outcomes, with key risk factors including patients having undergone multiple/complex procedures.•The use of TYRX envelope has been shown in prior studies to reduce the risk of CIED infections as well as Twiddler’s syndrome, although not in the 2 cases we have described.•In our cases, the use of TYRX has been associated with the formation of yellow viscous fluid, which in turn could promote hypermobility of the device and leads in the pocket and cause Twiddler’s syndrome.
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Liao et al. (2022) studied this question.
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