A 68-year-old female with a previous history of breast cancer treated by left mastectomy, chest radiotherapy and systemic chemotherapy was admitted to our cardiology department for syncope due to intermittent complete heart block and underwent right-sided dual-chamber pacemaker implantation using active fixation leads.
Three months after the procedure the patient was asymptomatic, but a pacemaker malfunction was detected with loss of pacing and sensing of both atrial and ventricular leads. A chest X-ray was performed which revealed coiling of the pacing leads around the pulse generator (Figure 1A). A diagnosis of twiddler's syndrome was made. The patient underwent surgical revision of the pacemaker pocket and the pacing system was removed (Figure 1B). A new pacemaker was implanted and anti-manipulation fixation was performed to prevent recurrence (Figure 1C).
The authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of dataThe authors declare that no patient data appear in this article.
Right to privacy and informed consentThe authors declare that no patient data appear in this article.
Conflicts of interestThe authors have no conflicts of interest to declare.
