José L. Morales et al. JACEP 2017;j.jacep

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Figure 2. Patient`s 12 Lead Electrocardiogram when she presented with palpitations and cardiac device firing on her latest hospital admission this year.

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José L. Morales et al. JACEP 2017;j.jacep.2017.02.015 A Case of ILM-t With Intravascular and Extravascular Coiling A 44-year-old woman with idiopathic cardiomyopathy and sustained ventricular tachycardia underwent single-chamber implantable cardiac defibrillator system implantation (Epic VR-196; ventricular lead Riata 7000-65 cm; St. Jude Medical, Saint Paul, Minnesota) on September 27, 2007. Thereafter, the patient was asymptomatic. However, on November 14, 2008, a routine device check-up showed failure to pace and sense, while multiple nonsustained ventricular fibrillation events were registered. A chest x-ray revealed retraction of the lead between both coils knotted like a treble clef at the junction of the right atrium and superior vena cava. A second coiling of the lead was seen at the level of the yoke. ILM-t = idiopathic lead migration (twiddler). José L. Morales et al. JACEP 2017;j.jacep.2017.02.015 2017 American College of Cardiology Foundation