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Late twiddler syndrome in a patient with a submuscular implantable cardioverter defibrillator
  1. Neiberg de Alcantara Lima1,
  2. Eduardo Arrais Rocha2,
  3. Francisca Tatiana Moreira Pereira2,
  4. Francisco daniel Cavalcante2
  1. 1Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  2. 2Department of Cardiology, Universidade Federal do Ceara Hospital Universitario Walter Cantidio, Fortaleza, Ceará, Brazil
  1. Correspondence to Dr Neiberg de Alcantara Lima, neiberg.lima{at}

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A 20-year-old woman with long-QT syndrome received a submuscular Fortify DR-St Jude implantable cardioverter defibrillator (ICD) after an episode of cardiac arrest. She felt an ICD pocket vibration 23 months later due to a high lead impedance and loss of capture. Chest radiography (figure 1A,B) showed both lead displacement and winding of the leads beside the ICD generator. These findings were confirmed during surgery (figure 1C). The patient strongly denied any box manipulation. She was discharged after new leads implantation with no complications.

Figure 1

(A) and …

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