Twiddler's syndrome

Background

• Implantable devices with attached wires traveling remotely are at risk for this complication.
• Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole."
• Wires dislodged from appropriate location in myocardium, often by patient 'twiddling' a recently-implanted pacemaker.

Clinical Features

• Pacemaker placed with poor function.
• Can present with syncope from lack of pacemaker function.
• Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position.

Differential Diagnosis

• Lead separation
• Lead dislodgement
• Lead infection
• See also pacemaker malfunction

Evaluation

Wrapped pacemaker lead showing Twiddler's syndrome.

Wrapped pacemaker lead showing Twiddler's syndrome.

• CXR to evaluate the placement of the leads

Management

• Cardiologist for device/lead placement

Disposition

• Admit to allow for device intervention as pacemaker does not function in Twiddler's Syndrome

See Also

• Pacemaker complication