植入性心臟去顫器旋弄症候群：一個罕見以打嗝表現引起去顫器功能失常的原因

Twiddler’s Syndrome: a rare cause of implantable cardioverter defibrillator malfunction presenting with hiccups

旋弄症候群是引起去顫器電極導線移位導致去顫器功能失常的罕見原因。我們報告一個以打嗝來表現的旋弄症候群案例。本病例報告的目的是報告一位57歲的男性，有擴張性心肌病變以及心室心搏過速的病史，18個月前接受過心臟去顫器植入治療。此次患者因頻繁打嗝與呼吸急促求診。檢查發現因去顫器電極導線在囊袋內扭絞和盤繞導致電極導線回縮而移位。我們的治療方法是手術將扭絞的導線與去顫器移除，從另一側植入新的導線與去顫器並加強縫線固定後，結果病人康復良好，追蹤5年並無復發情形。結論是植入性心臟去顫器旋弄症候群可以用頻繁打嗝來表現，重新手術再植入可以成功治療。

 

Twiddler’s syndrome is a rare cause of defibrillator lead displacement, resulting in de-fibrillator malfunction. The purpose of this report is to present the case of a 57-year-old man with history of dilated cardiomyopathy and ventricular tachycardia with dislodged de-fibrillator leads due to lead twisting and coiling in the defibrillator pocket at 18 months post-implantation. The patient presented to the hospital with frequent hiccups due to phren-ic nerve stimulation by the dislodged atrial lead. Our methods of treatment were removing the defibrillator generator and the twisted leads, and then implanting a new defibrillator generator and a new lead with reinforced stiches from the other side of the chest. The pa-tient recovered uneventfully. During follow-up, no migration of the lead and pulse genera-tor occurred for up to 5 years. In conclusion, frequent hiccups may be a presentation of Twiddler’s syndrome in patient with implantable cardioverter-defibrillator. The patient was successfully managed with re-implantation on the other side of chest.