Circulation. 1999;100:e45-e46
(Circulation. 1999;100:e45-e46.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
"Reel Syndrome"
A New Form of Twiddler's Syndrome?
Andrés Carnero-Varo, MD;
Matías Pérez-Paredes, MD;
José Antonio Ruiz-Ros, MD;
Diego Giménez-Cervantes, MD;
Francisco R. Martínez-Corbalán, MD;
Tomás Cubero-López, MD;
Pedro Jara-Pérez, MD
From the Cardiac Unit, University Hospital Morales Meseguer, Murcia,
Spain.
Correspondence to Dr Andrés Carnero-Varo, Unidad de Cardiología, Hospital Universitario Morales Meseguer, Avda Marqués de los Vélez s/n, 30.008, Murcia, Spain. E-mail matiasperez{at}medynet.com
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Introduction
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 Top
 Introduction
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A70-year-old man
with a history of rheumatic mitral stenosis
and valve
replacement was admitted to our hospital because of
near-syncope. A
12-lead ECG demonstrated atrial fibrillation
with a
ventricular response of 35 bpm. Evaluation with a 24-hour
Holter
monitor showed many episodes of prolonged pauses of >3 seconds.
A
ventricular-demand pacemaker was implanted to prevent
loss of
consciousness. A transvenous pacemaker electrode (Biotronik
SX
53-BP) was inserted via the right subclavian vein and connected
to the
pulse generator (Biotronik Dromos SR) implanted subcutaneously
in the
right subclavian area (Figures 1
and 2
). The patient
did well until 1
month after implantation, when he presented
again with
near-syncope. Evidence of pacemaker activity on the
ECG was absent even
after the application of a magnet on the
pulse generator. A chest
radiograph showed the lead coiling
around the pulse generator (Figure 3
). A new surgical procedure
was urgently
performed. During reimplantation, the pacemaker
lead was easily
uncoiled, repositioned, and carefully fixed
to the fascia. The
electrode was connected to the same pulse
generator. It was not
necessary to remove any device. During
the follow-up period of 20
months, there was no evidence of
new
complications.
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Figure 1. Chest radiograph showing a VVI pacemaker correctly
implanted after first surgical procedure.
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Figure 3. Radiograph demonstrating a pacemaker lead coiling
around pulse generator (the "reel syndrome"). Classically,
Twiddler's syndrome occurs in obese women with loose, fatty
subcutaneous tissue and is characterized by rotation of pulse generator
on its long axis with subsequent coiling of pacemaker lead. This
disorder may induce lead dislodgment or lead fracture and cause
life-threatening symptoms in case of pacemaker dependency. This case
represents a new form of Twiddler's syndrome characterized by
rotation of pulse generator on its transverse axis. Chest radiograph
was key to diagnosis and should always be performed when pacemaker
dysfunction is being investigated.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
