Fitzgerald D, Davis G M, Gottesman R, Fecteau A, Guttman F
Department of Respiratory Medicine, Montreal Children's Hospital/McGill University, Quebec, Canada.
Pediatr Pulmonol. 1996 Nov;22(5):319-21. doi: 10.1002/(SICI)1099-0496(199611)22:5<319::AID-PPUL5>3.0.CO;2-F.
Two patients with congenital central hypoventilation syndrome (CCHS) experienced phrenic nerve pacer failure due to deliberate manipulation of the internal receiver implant ("twiddling"). The patients, aged 7 and 12 years, presented with repeated episodes of pacer failure associated with local pain over a period of 18 months. They had progressively coiled the pacing wires to the point of breakage, which only became apparent at surgery. The breaks were not recognized radiologically, although in retrospect progressive twisting of the wires was evident on serial chest radiographs. Both patients required replacement of the internal receivers under general anesthesia. We recommend that the chest radiograph that is undertaken to investigate the cause of pacer dysfunction include the internal receiver. A plain chest radiograph that demonstrates progressive coiling of the subcutaneous pacing wire should raise suspicion of pacer wire breakage regardless of the patient's age.
两名先天性中枢性低通气综合征（CCHS）患者因故意摆弄体内接收器植入物（“旋转”）而出现膈神经起搏器故障。这两名患者年龄分别为7岁和12岁，在18个月的时间里反复出现起搏器故障，并伴有局部疼痛。他们逐渐将起搏导线盘绕至断裂，这在手术中才显现出来。尽管事后回顾连续胸部X线片上可见导线逐渐扭曲，但影像学上并未识别出断裂。两名患者均需要在全身麻醉下更换体内接收器。我们建议，为调查起搏器功能障碍原因而进行的胸部X线检查应包括体内接收器。无论患者年龄如何，显示皮下起搏导线逐渐盘绕的胸部平片均应引起对起搏导线断裂的怀疑。
