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To the Editor:
Jefferies and colleagues, in a recent issue of the Texas Heart Institute Journal, 1 described a case of defibrillator “twiddling” that partially dislodged the implanted electrodes. While references to the twiddling problem were made, there was no reference to a technique that can prevent both twiddling and device erosion—encasing the implanted pulse generator in a polyester-mesh pouch.2,3
We have used this pouch regularly for 35 years and have not seen any significant complication, except for an extremely rare reaction to the fibrous material. We continue to use the pouch in very thin patients in whom there is little overlying fibro-adipose tissue, and in patients whose implants are not placed beneath the pectoralis major muscle. Since making use of the pouch, we have not again seen twiddling or erosion of a device.
It would have been appropriate to report that there is a satisfactory method available to prevent twiddling and its complications.