Twiddler syndrome

Case contributed by Carlos Felipe Hurtado Arias


Multiple cardiovascular risk factors. History of cardiac transplant 7 years ago, and cardiac resynchronisation implant 6 years ago. Since, 1 week has progressive dyspnea, paroxysmal nocturnal dyspnea, orthopnea and edema of the lower limbs. The physical examination documented jugular engorgement and rales in both lungs.

Patient Data

Age: 80 years
Gender: Male

The cardiac silhouette is enlarged. Precapillary pulmonary hypertension. Pulmonary edema in the interstitial phase.

Cardiac resynchronisation device in the soft tissues of the anterior wall of the chest, contacting the left pectoral muscle. The three electrodes of the cardiac device are retracted, without contact with the myocardium, and whose distal ends are located in the superior vena cava, confluent subclavian-jugular and left subclavian.

Case Discussion

This is a case of an older adult with a history of cardiac transplantation, who has symptoms and signs of acute heart failure. The treating physicians thought of an infectious pulmonary pathology as a trigger.

It must be taken into account that the cardiac resynchronisation device was implanted one year after the transplant was performed. The disconnection of the cardiac resynchronising system, known as Twiddler syndrome, leads to inadequate functioning of the myocardium, with symptoms such as this given the disordered functioning and contraction.

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