背景:心脏植入式电子设备(CIED)并发症在临床实践中提出了重大挑战,尤其是患有多种合并症的老年患者。常见的不良事件包括感染,导线故障,和设备迁移。Twiddler综合征,一种罕见但严重的ED并发症,其特征是患者操作导致导线移位和设备故障,经常被低估。文献主要由病例报告和小系列组成,在预防和管理方面提供有限的指导。AsCIED对于管理心律失常和心力衰竭至关重要,理解和解决Twiddler综合征至关重要。本病例报告旨在通过详述Twiddler综合征的病例来为文献做出贡献,强调多学科方法对优化管理的重要性。
方法:一名59岁男性在过去两天内出现植入式心脏复律除颤器(ICD)部位和胸骨区域周围的不适。他否认疼痛,呼吸困难,或者头晕.临床检查显示心律正常,无外周脉搏不足。超声显示左心室射血分数降低。心房导线不可见,电击线圈放错了地方。ICD询问显示由于两条导线中的感应伪影和出口阻塞而导致的不适当电击,没有检测到心律失常.X射线证实了铅移位和口袋中的明显缠结。患者被诊断为Twiddler综合征,并计划进行手术翻修。
结论:扩张型心肌病(DCM),以左心室扩张和功能障碍为特征,占收缩性心力衰竭病例的很大比例。尽管在心力衰竭管理方面取得了进展,DCM患者仍然处于心源性猝死(SCD)的高风险,使ICD植入至关重要。然而,CIED放置有并发症的风险,包括Twiddler综合征.这种情况可能导致导线移位和设备故障,导致不适当的电击和潜在的患者伤害。在这种情况下,使用多学科方法成功进行了单次摘除和重新植入,强调综合管理策略对有效解决此类并发症的重要性。定期随访显示无不良事件,强调该程序的成功和使用先进的抗菌辅助预防感染的潜在好处。该病例强调了管理Twiddler综合征的意识和标准化方案的必要性,以改善日益增长的CIED接受者人群的患者预后。
BACKGROUND: Cardiac implantable electronic device (CIED) complications present significant challenges in clinical practice, especially in elderly patients with multiple comorbidities. Common adverse events include infection, lead malfunction, and device migration. Twiddler\'s Syndrome, a rare but serious CIED complication characterised by patient manipulation causing lead displacement and device malfunction, is often underreported. The literature consists mainly of case reports and small series, providing limited guidance on prevention and management. As CIEDs are critical for managing cardiac arrhythmias and heart failure, understanding and addressing Twiddler\'s Syndrome is essential. This case report aims to contribute to the literature by detailing a case of Twiddler\'s Syndrome, emphasising the importance of a multidisciplinary approach for optimal management.
METHODS: A 59-year-old male presented with discomfort around his implantable cardioverter defibrillator (ICD) site and the sternal area over the past two days. He denied pain, dyspnoea, or dizziness. Clinical examination revealed a normal heart rhythm and no peripheral pulse deficit. Ultrasound revealed a reduced left ventricular ejection fraction. The atrial lead was not visible, and the shock coil was misplaced. ICD interrogation showed inappropriate shocks due to sensing artifacts and exit block in both leads, with no arrhythmias detected. An X-ray confirmed lead dislodgement and significant entanglement in the pocket. The patient was diagnosed with Twiddler\'s Syndrome and scheduled for surgical revision.
CONCLUSIONS: Dilated cardiomyopathy (DCM), characterised by left ventricular dilatation and dysfunction, accounts for a significant proportion of systolic heart failure cases. Despite advancements in heart failure management, DCM patients remain at high risk for sudden cardiac death (SCD), making ICD implantation crucial. However, CIED placement carries risks of complications, including Twiddler\'s Syndrome. This condition can lead to lead dislodgement and device malfunction, resulting in inappropriate shocks and potential patient harm. In this case, a single-session extraction and re-implantation were successfully performed using a multidisciplinary approach, emphasising the importance of comprehensive management strategies to address such complications effectively. Regular follow-up showed no adverse events, highlighting the procedure\'s success and the potential benefits of using advanced antimicrobial adjuncts to prevent infections. This case underscores the need for awareness and standardised protocols for managing Twiddler\'s Syndrome to improve patient outcomes in the growing population of CIED recipients.