PMC9845543_01
Case 1: Chest radiographs showing device and leads positioning immediately after implant (left) and evidence of Twiddler's syndrome 3 weeks later (right).
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Her chest radiograph demonstrated evidence of macro lead dislodgement and retraction (Figure 1) and device interrogation showed a marked increase in the left ventricular lead impedance and threshold.
Case 1: Yellow viscous fluid seen in the device pocket during lead extraction.
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At this procedure, yellow viscous fluid in the pocket was seen together with tangled leads (Figure 2).
PMC9845543_02
Case 2: Chest radiographs showing evidence of Twiddler's syndrome (top) and yellow viscous fluid seen in the pocket during lead extraction (bottom).
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At follow-up 2 months post generator change, repeat chest radiography showed her leads to have become entangled within the pocket (Figure 3). Intraprocedurally, there was yellow viscous fluid within the device pocket (Figure 3), but otherwise no clinical evidence of infection.