ArticleEuropean heart journal. Case reports2019
Twiddler's syndrome with a subcutaneous implantable cardioverter-defibrillator presenting with an inappropriate shock: a case report.
Article in European heart journal. Case reports, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
8 citing papers in PubMed, 10 citations in OpenAlex.
- Twiddler syndrome and Reel syndrome in patients with subcutaneous implantable cardioverter-defibrillator (S-ICD): a meta-summary of case reports.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Review
- A hidden twist: Twiddler's syndrome presenting as inappropriate shock in a subcutaneous implantable cardioverter-defibrillator.European heart journal. Case reports · 2026Article
- Inappropriate S-ICD Shock Related to Reel Syndrome.JACC. Case reports · 2025Article
- (Non) twiddler syndrome in a subcutaneous implantable cardioverter-defibrillator patient-fixation first?Oxford medical case reports · 2025Article
- Subcutaneous Implantable Cardioverter-Defibrillator Lead Dislodgement Masquerading as Left Shoulder Pain.Cureus · 2023Article
- S-ICD Implantation "Tips and Tricks".Reviews in cardiovascular medicine · 2023Review
- Isolated subcutaneous implantable cardioverter-defibrillator generator displacement causing inappropriate shocks despite preserved lead tip and coil position: a case report.European heart journal. Case reports · 2023Article
- Twiddler's syndrome after implantation of baroreflex activation therapy: a case report.European heart journal. Case reports · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSubcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients at risk of fatal cardiac arrhythmias. Twiddler's syndrome is a condition in which a device is manipulated by the patient after implantation leading to lead twisting and retraction. Device manipulation has been reported multiple times in transvenous pacing systems and occasionally leads to inappropriate discharges from implanted defibrillators. However, little has been reported about device manipulation in S-ICD devices. CASE SUMMARY: We present the case of a 16-year-old who underwent insertion of an S-ICD for idiopathic dilated cardiomyopathy. He represented for a pacing check following a discharge from the device. This showed a significant change in the sensed vectors. Chest radiographs confirmed lead retraction and suggested device manipulation. The device was turned off to prevent further inappropriate shocks. The patient underwent successful reimplantation of a S-ICD device. DISCUSSION: This case highlights that twiddler's syndrome can occur in those with an S-ICD and lead to an inappropriate device discharge. The patient in this case had a number of risk factors that have been previously associated with twiddler's syndrome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.