Author + information
- Received June 30, 2015
- Revision received February 15, 2017
- Accepted February 24, 2017
- Published online November 20, 2017.
- José L. Morales, MD,
- Santiago Nava, MD∗ (, )
- Manlio F. Márquez, MD,
- Jorge González, MD,
- Jorge Gómez-Flores, MD,
- Luis Colín, MD,
- Marco A. Martínez-Ríos, MD and
- Pedro Iturralde, MD
- Department of Electrocardiology, National Institute of Cardiology “Ignacio Chavez,”, Mexico City, Mexico
- ↵∗Address for correspondence:
Dr. Santiago Nava, Instituto Nacional de Cardiología “Ignacio Chávez,” Department of Electrocardiology, Juan Badiano 1. Col. Sección XVI, Tlalpan 14080, México City, México.
Objectives This cumulative case study was performed to properly address the possible mechanisms, forms, and consequences of “twiddler’s,” “reel,” and “ratchet” syndromes.
Background Twiddler’s, reel, and ratchet syndromes are rare entities responsible for lead displacement of cardiac implantable electronic devices (CIED).
Methods From 2007 to 2012, 1,472 CIED were implanted at our center. Eighty-nine cases were reviewed for failure of pacing circuit integrity. Only 9 met the inclusion criteria for idiopathic lead migration (ILM) and were grouped as ILM (twiddler) or ILM (reel). For a pooled analysis of cases, a review of the literature from 1990 to 2012 was performed, and the authors identified 78 cases from 64 publications.
Results The study population consisted of 87 cases (45 women; median age, 66 years; 46 with ILM [twiddler] and 41 with ILM [reel]). Migration affected only 1 lead in 65% of 46 devices with more than 1 lead. None of the previously reported risk factors—manual manipulation of the device, elderly age, obesity, oversized pocket, and psychiatric history—correlated with the risk of ILM.
Conclusions Neither manual manipulation of the device nor the other traditional risk factors reported in the literature for ILM syndrome correlated with the risk of ILM.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 30, 2015.
- Revision received February 15, 2017.
- Accepted February 24, 2017.
- 2017 American College of Cardiology Foundation