RESUMO
Twiddler syndrome is an exceptional cause of dysfunction of cardiac prostheses resulting from a displacement of the probe either by deliberate or unconscious manipulation. We report the case of a man admitted for a respiratory arrest (ACR) caused by an extreme bradycardia. Initially implanted 6 weeks earlier for idiopathic ventricular fibrillation without documented ischemic causes or major conduction disorders. The patient has benefited from extraction with reimplantation of a new defibrillation probe. The originality of this observation is underlined by the occurrence of a previously unrecognized inaugural syncopal atrioventricular block revealing Twiddler syndrome in a patient initially implanted with a secondary prevention defibrillator for idiopathic ventricular fibrillation.
Le syndrome de Twiddler est une cause exceptionnelle de dysfonction de prothèses cardiaques résultant d'un déplacement de sonde secondaire à la manipulation délibérée ou inconsciente du boîtier. Nous rapportons le cas d'un patient admis pour arrêt cardiorespiratoire sur bradycardie extrême et initialement implanté 6 semaines plus tôt pour une fibrillation ventriculaire idiopathique sans cause ischémique documentée ni troubles de conductions majeurs. Le patient a ainsi bénéficié d'une extraction avec réimplantation d'une nouvelle sonde de défibrillation. L'originalité de cette observation est soulignée par la survenue d'un bloc auriculoventriculaire syncopal inaugural jusque-là méconnu révélant un syndrome de Twiddler chez un patient initialement implanté d'un défibrillateur en prévention secondaire pour une fibrillation ventriculaire idiopathique.
Assuntos
Bradicardia/etiologia , Desfibriladores Implantáveis/efeitos adversos , Parada Cardíaca/etiologia , Fibrilação Ventricular/terapia , Idoso , Bradicardia/diagnóstico , Remoção de Dispositivo , Falha de Equipamento , Parada Cardíaca/diagnóstico , Humanos , Masculino , Reoperação , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , SíndromeRESUMO
A 12 year-old boy, with no history of cardiac disease, was referred to our department for evaluation of an incessant accelerated idioventricular rhythm (AIVR) complicated with severe left ventricular (LV) dysfunction and cardiogenic shock. Extensive diagnostic work-up failed to reveal any structural heart disease. During electrophysiological study, AIVR originated from the right ventricular endocardial anterior wall and was successfully ablated using remote magnetic navigation. LV function showed complete recovery four weeks after the procedure. This case highlights a life-threatening evolution of an arrhythmia generally presented as a benign entity in children.