Infection and Twiddler Syndrome in a Dog With Addison's Disease, Complete Heart Block, and Wandering Artificial Pacemakers

Third-degree heart block developed in an obese seven-year-old dog with adrenal cortical failure. After three days of extensive medial therapy and use of a temporary transvenous pacemaker, a transthoracic permanent pacemaker was implanted in the usual paracostal location. After two years of normal function, the pulse generator suddenly migrated to a ventral location in the flank and became surrounded by an abscess. Intermittent pacing failure ensued. Medical therapy with antibiotics failed to eliminate infection until the infected pacemaker and site were excised surgically. A new pacemaker was placed on the opposite side and functioned well for two months. Subsequent migration and rotation of the new pacemaker led to spiral twisting of the lead and dislodgment of the corkscrew electrode from the myocardium in a syndrome analogous to Twiddler's syndrome in man. The dog presently is 10 years old and asymptomatic with a nonpaced ventricular rhythm of 60 beats per minute and an usual chest radiograph.