Key result
A 63-year-old male experienced pacemaker lead dislodgement due to a combination of Twiddler's and ratchet syndromes, requiring surgical revision of his biventricular ICD.
Why the study?
Twiddler syndrome with an underlying ratchet mechanism is rarely reported in the literature as a cause of pacemaker lead displacement.
Case Report (n=1)
This case report highlights a rare presentation of Twiddler's syndrome with an underlying ratchet mechanism leading to ICD lead dislodgement and heart failure exacerbation.
Rare lead displacement syndromes may underlie HF exacerbation post-device implant; hypothesis-generating and should not yet change practice.
Twiddler's syndrome, reel syndrome, and ratchet phenomenon are rare causes of pacemaker lead displacement. The presentation of Twiddler's syndrome with underlying ratchet mechanism is quite rarely reported in literature. In this case report we present a 63-year-old male with a history of non-ischemic cardiomyopathy who had his biventricular implantable cardioverter defibrillator leads dislodged and presented as sub-acute exacerbation of heart failure. This case highlights the underlying mechanism of twiddler's syndrome, its clinical presentation, management, and prevention.
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Iftikhar et al. (2019) conducted a case report in Twiddler's syndrome and Ratchet syndrome (n=1). Biventricular implantable cardioverter defibrillator (BIV-ICD) placement was evaluated. A 63-year-old male experienced pacemaker lead dislodgement due to a combination of Twiddler's and ratchet syndromes, requiring surgical revision of his biventricular ICD.
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