Machraa Achraf, Sidaty Oussama, Fellat Nadia, Fellat Rokaya
Dept. of Cardiology A, National Cardiovascular League, Ibn Sina University Hospital Center, Mohammed V University, Rabat, Morocco.
Ann Med Surg (Lond). 2022 Nov 11;84:104857. doi: 10.1016/j.amsu.2022.104857. eCollection 2022 Dec.
Lead dislodgement syndromes (Twiddler, Ratchet or Reel syndromes) are rare causes of cardiac stimulation device malfunction that can occur most commonly early after device implantation. Each one of them associated with a unique pattern of lead coiling and dysfunction. Our clinical case reports an unusual association and shed the light on the available diagnostic modalities.
A 62-year-old woman who was referred to our hospital for a symptomatic high degree AV block, she underwent dual chamber pacemaker implantation. She experienced 3 weeks following implantation a rhythmic twitching of the right arm without syncope. The device interrogation revealed an increase in both leads pacing impedance and chest X-ray showed leads had pulled out of the heart and were tangling and wrapped repeatedly around the pulse generator. Revision procedure was performed to reposition the leads.
Recognizing this complication early can prevent life threatening complication and is then of the utmost importance. Twiddler's syndrome is due to rotation of the device along its long axis. Reel syndrome is produced by device rotation along the transverse axis. In most cases, lead replacement or reposition is needed. Preventive measures such as patient education and use of a smaller pocket will reduce the risk of developing the syndrome.
Our case highlights the available diagnostic modalities for early detection of twiddler's syndrome. The unique nature of this case increases the importance of considering device lead dislodgement as the cause for patients presenting with extra-cardiac symptoms.
导线移位综合征（Twiddler综合征、棘轮综合征或卷轴综合征）是心脏刺激装置故障的罕见原因，最常发生在装置植入后的早期。它们每一种都与独特的导线盘绕模式和功能障碍相关。我们的临床病例报告了一种不寻常的关联，并阐明了现有的诊断方法。
一名62岁女性因有症状的高度房室传导阻滞被转诊至我院，她接受了双腔起搏器植入术。植入后3周，她出现右臂有节律的抽搐，无晕厥。对装置进行问询发现两根导线的起搏阻抗均增加，胸部X线显示导线已从心脏拔出，并反复缠绕在脉冲发生器周围。进行了翻修手术以重新定位导线。
早期识别这种并发症可预防危及生命的并发症，因此至关重要。Twiddler综合征是由于装置沿其长轴旋转所致。卷轴综合征是由装置沿横轴旋转产生的。在大多数情况下，需要更换或重新定位导线。诸如患者教育和使用较小的囊袋等预防措施将降低发生该综合征的风险。
我们的病例突出了早期检测Twiddler综合征的现有诊断方法。该病例的独特性质增加了将装置导线移位视为出现心脏外症状患者病因的重要性。
