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KOOIMAN, ET AL.
Figure 1. Captured electrocardiograms of all three sensing vectors directly postimplant and at presentation with
Twiddler syndrome.
Figure 2. Chest x-rays. Panel (A) Directly after initial implant. Panel (B) Presentation with Twiddler syndrome. Panel
(C) After extraction of initial system and reimplantation of new subcutaneous implantable cardioverter defibrillator
system (emblem) under serratus anterior muscle.
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Discussion
To our knowledge, this report is the first
reported case of an S-ICD lead failure caused
by mechanical stress. Long-term follow-up in
two large registries showed no lead fractures up
to 3 years.3 However, the robust design of the
subcutaneous lead is not immune to excessive
mechanical force. In the current case, the system
was still able to adequately sense the heart rhythm
as the signals could still be obtained in the programmed sensing vector. However, if the device
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PACE, Vol. 38
References
1. Boyle NG, Anselme F, Monahan KM, Beswick P, Schuger
CD, Zebede J, Josephson ME. Twiddlers syndrome variants
in ICD patients. Pacing Clin Electrophysiol 1998; 21:2685
2687.
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