The pulse generator was also fixed to the underlying pectoral muscle with non-absorbable stay suture. A bipolar active fixation, screwing lead was placed at the right ventricular apex. JUDE -VVI) was implanted in the right infra-clavicular area. A Single chamber permanent pacemaker (ST. Echocardiography showed mild dilatation of the left atrium, mild concentric left ventricular hypertrophy with an ejection fraction of 60%. All the reversible causes of the condition were ruled out. Temporary pacemaker lead was inserted through the right femoral venous route. Electrocardiogram showed atrial fibrillation with a ventricular rate of 34/minute. On admission pulse was 34/minute and blood pressure was 160/90 mmHg. She is also a case of the chronic obstructive pulmonary disease. She is a known diabetic and hypertensive. We report a case of 84-year-old female who presented with syncope and twitching sensation in the right upper quadrant of the abdomen, 4 weeks after the implantation of a permanent pacemaker.Ĩ4-year-old female was admitted with recurrent syncope. The coiling of the lead results in lead retraction, lead damage and cause lead fracture or insulation leakage. This results in coiling of the pacemaker lead due to the rotation of pacemaker generator on its long axis. It occurs because of unintentional or deliberate manipulation of the pulse generator within its skin pocket by the patient. in 1968, when a patient manipulated and rotated the pulse generator in the pocket resulting in lead dislodgement, diaphragmatic stimulation, and loss of capture. Twiddler's syndrome was first described by Bayliss, et al. Twiddler's syndrome, Lead dislodgement, Pacemaker malfunction We report a case of 84-year-old female who was readmitted after 4 weeks of implantation of permanent pacemaker with syncope and diaphragmatic stimulation. The treatment involves readmission, repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. It usually occurs in the first year following pacemaker implantation. In a pacemaker dependent patient, it can be a lethal complication. It results in lead dislodgment, diaphragmatic stimulation, and loss of capture. It is caused by conscious or unconscious manipulation at the implantation site by the patient with the result of device malfunction. doi: 10.14503/THIJ-16-5918.Twiddler's syndrome is a rare complication after pacemaker implantation. Complications arising from cardiac implantable electrophysiological devices: review of epidemiology, pathogenesis and prevention for the clinician. HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations. Wilkoff BL, Auricchio A, Brugada J, et al. Actions elicited during scheduled and unscheduled in-hospital follow-up of cardiac devices: results of the ATHENS multicenter registry. Mascioli G, Curnis A, Landolina M, et al. Pacemaker and ICD generator malfunctions analysis of Food and Drug Administration Annual Reports. Maisel WH, Moynahan M, Zuckerman BD, et al. A knowledge of these factors is essential for health care providers, given the morbidity and mortality that can potentially be associated with device-related issues, especially in patients who are dependent on the included pacing function.Ĭardiac implantable electronic devices implantable cardioverter-defibrillator malfunction loss of capture noncapture pacemaker malfunction.Ĭopyright: © 2020 Innovations in Cardiac Rhythm Management. Further, there are also potential noncardiac causes, such as medications, electrolyte imbalance, and acidemia. Loss of capture can also occur from external electrical stimuli and inappropriate pacemaker or ICD settings. This change can be due to a cardiomyopathy, fibrosis medications, metabolic imbalance, lead fracture, or an exit block. In comparison, an increase in the required threshold promoting a loss of capture can happen after months to years of insertion of the pacemaker or ICD. The most common acute cause just after the insertion procedure is lead dislodgement or malposition. There are many causes for a loss of capture, with the timing of the implant having a high correlation with certain causes over others. Loss of capture can be an emergent presentation for an unstable patient and can be encountered intermittently in hospitalized patients. As more pacemakers and implantable cardioverter-defibrillators (ICDs) are being placed, a basic understanding of some troubleshooting for devices is becoming essential. The number of patients with implantable electronic cardiac devices is continuously increasing.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |