| Summary: | This report explains the Twiddler's syndrome, a well known human entity, in a canine model. We also describe a modified technique to implant internal cardioverter defibrillators (ICD) in dogs to prevent Twiddler's syndrome. Our original study was to identify the factors influencing the DFT measurement and a canine model was selected as it is the best proven electrophysiological model. During the course of the study, one of the dogs was evaluated for device failure at three weeks following implantation. While under general anesthesia, interrogation of the dog's ICD showed that the right ventricular (RV) pacing threshold was high and ventricular capture was intermittent. When examined under fluoroscopy, it was noted that the defibrillator lead was dislodged from the right ventricular apex. A surgical revision of the device pocket showed that the leads were twisted in an almost braided fashion - as if "twiddled" into position around the device [Figure1 (arrow)]. We suspect that this "twiddling" resulted in shortening and pulling of the lead from the ventricular myocardium causing intermittent capture and device failure.
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