Pacing and clinical electrophysiology : PACE
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Three cases of twiddler's syndrome in patients with an abdominally implanted cardioverter defibrillator (ICD) and an endocardial lead system are reported. The condition was detected when an increase in pacing threshold or lead impedance was noted at routine follow-up. ⋯ Elderly female patients with some degree of obesity appear most susceptible. Minimizing pocket size and suturing of the device to the fascia should decrease the chance of developing this problem.
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Pacing Clin Electrophysiol · Dec 1998
Case ReportsCombined use of a true-bipolar sensing implantable cardioverter defibrillator in a patient having a prior implantable spinal cord stimulator for intractable pain.
Reported is a case involving a patient with a previously implanted spinal cord stimulator (SCS) who presented for an implantable cardioverter defibrillator (ICD). The SCS device was located in the left lower abdominal quadrant with a stimulation electrode array placed on the dorsal aspect of the spinal cord at the T-11 thoracic level. Interaction testing demonstrated that the biopolar sensing transvenous ICD system (Medtronic 7221 Cx PCD) did not detect the stimulator's output at burst rates ranging from 20-130 pulses/s, even with the ICD set to its maximum sensitivity of 0.15 m V and the stimulator programmed to the highest patient tolerated output combinations of 5 V, 0.45 ms in the bipolar configuration and 3 V, 0.45 ms in the unipolar (i.e., case-electrode) configuration.