Twiddler's syndrome variants in ICD patients

Three cases of twiddler's syndrome in patients nifh an abdominally implante d cardioverter defibrillator (ICD) and an endocardial lead system are repor ted. The condition was detected when an increase in pacing threshold or lea d impedance was noted at routine follow-up. Successful revision as possible in all patients; however, a recurrence in one patient necessitated removal of the device. Elderly female patients with some degree of obesity appear most susceptible. Minimizing pocket size and suturing of the der ice to the fascia should decrease the chance of developing this problem.