PMC4721019_01
ECG tracing during initial presentation showing different arrhythmias. a Complete heart block, b 2:1 Atrio-ventricular block, c Sinus bradycardia
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PMC4721019_01_13104_2015_1818_Fig1_HTML.jpg
Fig1
An immediate ECG revealed intermittent complete heart block alternating with junctional rhythm and sinus bradycardia, with a heart rate of approximately 42 beats/minute (Fig. 1).
ECG tracing after Twiddler's syndrome developed. ECG tracing showing complete heart block with pacemaker spikes (red arrows) and failure to capture
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PMC4721019_01_13104_2015_1818_Fig2_HTML.jpg
Fig2
The ECG showed complete heart block with pacemaker spikes and failure to capture (Fig. 2).
Chest X-ray demonstrating evidence of Twiddler's syndrome. a Chest X-ray posterior-anterior view showing coiling of the proximal part of ventricular lead and rotated pulse generator with its head pointing downwards (red arrow) and displaced tip of the right ventricular lead (orange arrow). b Chest X-ray lateral view showing the distal end of the ventricular lead in the right atrium (green arrow)
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PMC4721019_01_13104_2015_1818_Fig3_HTML.jpg
Fig3
The distal end of the ventricular lead was seen in the right atrium (Fig. 3).