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Background <p>Twiddler and Reel syndrome are mechanical complications of transvenous devices and are rarely reported in subcutaneous ICD (S-ICD) recipients.</p> Methods <p>We reviewed published cases and report Reel syndrome in a 15-year-old patient with an S-ICD, the youngest described.</p> Results <p>Ten cases were identified. The most common clinical presentation was inappropriate shocks due to altered sensing vectors. Diagnosis was confirmed by device interrogation and chest radiography. Risk factors are similar to those observed in transvenous devices.</p> Conclusions <p>Twiddler and Reel syndrome can occur in S-ICDs and should be considered in the differential diagnosis of inappropriate shocks or device malfunction.</p>

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Twiddler syndrome and Reel syndrome in patients with subcutaneous implantable cardioverter-defibrillator (S-ICD): a meta-summary of case reports

  • 期刊论文

  • 发表日期：

    2026年4月15日

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  • Giovanni Domenico Ciriello,
  • Diego Colonna,
  • Anna Correra,
  • Giovanni Papaccioli,
  • Emanuele Romeo,
  • Giuseppe Limongelli,
  • Berardo Sarubbi

摘要

Background

Twiddler and Reel syndrome are mechanical complications of transvenous devices and are rarely reported in subcutaneous ICD (S-ICD) recipients.

Methods

We reviewed published cases and report Reel syndrome in a 15-year-old patient with an S-ICD, the youngest described.

Results

Ten cases were identified. The most common clinical presentation was inappropriate shocks due to altered sensing vectors. Diagnosis was confirmed by device interrogation and chest radiography. Risk factors are similar to those observed in transvenous devices.

Conclusions

Twiddler and Reel syndrome can occur in S-ICDs and should be considered in the differential diagnosis of inappropriate shocks or device malfunction.